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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1192_Библиотеки_им_академика_М_И_Перельмана
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Index
A
Abdominal perineal resection
anatomy restoration, 111, 112
anus closure, 110
clinical indications, 107, 108
colostomy creation and closure, 118, 120
denition, 107
IMA pedicle, 112
inferior mesenteric artery and vein division, 112–114
intra-levator dissection, 123
left colon mobilization, 114
mesorectal space, 112
metastatic disease, 111
omental pedicle ap, 118
operation steps, 108
operation tools, 108
patient positioning, 109, 110
perineal dissection, 120–122
perineal retraction, 120
pneumoperitoneum
with incision, 120
in obese, 110
during trephine creation, 118
port placement, 110, 111
posterior dissection, 120
preoperative planning, 108
preoperative stoma marking, 122
prone dissection, 122
retraction of uterus, 111
retractor tension, 115
sigmoid colon and mesocolon, 117–119
stoma creation, 118
stoma length, 114
T4b tumors, 123
total mesorectal excision, 115–117
ureter identication, 113
uterine retraction, 111
vaginal retraction, 117
B
Baker anastomosis, 79, 80
Bleeding complications
mesenteric vessel during ligation and division
identication, 178
prevention, 177, 178
treatment, 178
presacral bleeding during proctectomy
identication, 180
prevention, 180
treatment, 180, 181
secondary to excessive traction
identication, 179
prevention, 178, 179
treatment, 179
Blunt adhesiolysis, 163
C
Carter-Thomason® suture passer, 176
Closed-loop obstruction, 168
Complications during dissection
bleeding
mesenteric vessel during ligation
and division, 177, 178
presacral bleeding during proctectomy, 180, 181
secondary to excessive traction, 178, 179
bowel injury
identication, 181
prevention, 181
treatment, 182
Crohn’s disease, 168, 169
Crohn’s stula, 169
E
End-to-end anastomosis (EEA) stapler, 67
Entry complications
bleeding from abdominal vessels during entry
prevention, 174
recognition, 174
treatment, 175
bleeding from abdominal vessels during port
placement
complications, 175
recognition, 175
treatment, 175, 176
bowel injury during entry into the abdomen
© Springer Nature Switzerland AG 2020
S. L. Stein, R. R. Lawson (eds.), Laparoscopic Colectomy,
https://doi.org/10.1007/978-3-030-39559-9
187
188
Index
Entry complications (cont.)
etiology of injury, 173
extent of injury, 173
identication, 172, 173
location of injury, 173
prevention, 171–172
treatment, 173, 174
F
Familial adenomatous polyposis (FAP), 66
Fistula/phlegmon in diverticular disease, 83
G
Gerota’s fascia, 45, 93
Glove single-site platform, 167
Gore® suture passer, 176
H
Hassan trocar, 18
Hereditary nonpolyposis colorectal
cancer (HNPCC), 66
Hydropneumatic leak test, 82
I
Inferior mesenteric artery (IMA), 69–71
Intra-levator dissection, 123
Intraoperative complications
complications during dissection (see Complications
during dissection)
entry complications (see Entry complications)
splenic injury
identication, 185
prevention, 184, 185
treatment, 185
ureteral injury
identication, 184
injury location, 182
prevention, 182–184
treatment, 184
L
Lapra-Ty® (Ethicon), 34
Lysis of adhesions and bowel obstruction
adhesiolysis
blunt adhesiolysis, 163
energy dissection, 163
sharp dissection, 163
visualization, 164
adhesions, 162
clinical indications, 159
closed-loop obstruction, 168
conversion to open surgery, 167
Crohn’s disease, 168, 169
denition, 159
dense adhesions, 162
dilated bowel, 165
initial inspection and port placement, 162
laparoscope, 162
Meckel’s diverticulum, 168
missed enterotomy, 167
monopolar scissors, 164
neoplasm, 169
operation steps, 160
operation tools, 160
patient positioning, 160
peritoneal entry, 160
preoperative planning, 160, 161
progression monitoring, 163
right side adhesions, 162
running the bowel, 164–166
scope choice, 162
serosotomy repair, 166
single band adhesiolysis, 167
Veress needle aspiration, 161
M
Meckel’s diverticulum, 168
N
Neoplasm, 169
O
Ole procedure, 42
Open Hassan technique, 4
P
Palmer’s point, 5
Proctectomy
assistant placement on left colectomy, 88
blood supply, 100
circular stapler anvil attachment, 101
coloanal anastomoses, 103, 104
colorectal types, 103, 104
denition, 85
hand-assisted laparoscopic surgery, 103
hand-sewn colon anal anastomosis, 105
indications, 85
instrument choice, 89
operating tools, 86
operative strategy
anastomosis, 101, 102
closure, 102
colon exteriorization, 100
inferior mesenteric artery, 91–93
inferior mesenteric vein, 93, 94
laparoscopy staging, 89
loop ileostomy, 102
pathology identication, 89
port placement, 88, 89
renal transection, 98–100
retroperitoneal plane creation, 89–91
Index
189
sigmoid and descending colon, 94
specimen resection, 100, 101
splenic exure mobilization, 94–96
patient positioning, 86–88
pelvic angles, 99
preoperative planning, 85, 86
rectosigmoid tension, 91
right-sided pelvic adhesions, 89
ureter stents, 92
vessel sealing, 92
Proctocolectomy with ileal pouch anal anastomosis
clinical indications, 141
colectomy, medial-to-lateral approach, 147
countertension for obese patients, 148
denition, 141
endostapler, 146
externalizing colectomy, 150
hepatic exure, 146, 147
ileocolic artery in pouch patients, 146
laparoscopically guided initial abdominal entry, 144
left colectomy, 147–149
loop ileostomy diversion, 157, 158
mesenteric windows, 146
mesorectal dissection for benign disease, 150
operation steps, 142
operation tools, 142
patient positioning, 143, 144
peritoneal cavity inspection, 144
perpendicular stapler line in the pelvis, 153
pneumoperitoneum reestablishment, 150
port placement, 144
posterior approach, 144
pouch-anal anastomosis, 156, 157
pouch conformation, 154
pouch construction, 153–156
preoperative planning, 141, 142
proctectomy, 150–152
protection against pouch-vaginal stulas, 157
rectal cancers, 152
rectum transection, 152, 153
retracting in two planes, 148
right colon dissection, 144–146
specimen externalization, 153
transverse colectomy/splenic exure mobilization,
149, 150
uterus retraction, 152
Prone dissection, 122, 123
R
Right colectomy
anastomosis, 28
bottom-up approach, 30
clinical indications, 15
closure, 28
colon and small bowel preparation
anastomosis stapling, 33
bowel overlapping for intracorporeal
anastomosis, 32
enterotomy creation, 32, 33
enterotomy suturing, 33, 34
stabilizing suture placement, 32
transection, 32
colon tattooing, 19
Crohn’s disease, 31
denition, 15
delayed ICA transection, 22
hepatic exure mobilization, 25, 26
ileocolic pedicle identication and transection, 20–22
intracorporeal anastomosis, 31
laparoscopic staging, 19
lateral mobilization, 25, 26
lateral to medial approach, 30, 31
lesser sac, 24, 25
maximizing traction, 23
middle colic arteries identication and transection, 23
multiple staple lines, 32
normal anatomy restoration, 19
operation steps, 16
operation tools, 16
pathology identication, 19, 20
patient positioning, 17, 18
port placement, 18, 19
preoperative planning, 15
retroperitoneal plane dissection, 22, 23
scissors or bipolar, 25
small bowel, 19
specimen externalization, 27, 28
tension on anastomosis, 34
terminal ileum, 26, 27
top-down approach, 30
transection margins, 28
transverse colon mesenteric transection, 23, 24
S
Sigmoid colectomy
air leak testing, 81, 82
anastomosis creation, 81
Baker anastomosis, 80
clinical indications, 65
closure, 82
denition, 65
diagnostic laparoscopy, 69
distal transection, 77, 78
endoscopic tattoo, 69
end-to-end anastomosis, 79, 80
extraction and proximal transection, 79
stula/phlegmon in diverticular disease, 83, 84
Hartmann’s reversal, 84
IMV pedicle transection, 72–75
inferior mesenteric artery, 69–71
lateral dissection, white line of Toldt, 74, 75
leak test, 82
left colic artery in benign disease, 73
medial-to-lateral dissection, retroperitoneal
plane, 73, 74
mesorectal plane, 72
neoplasia location, 66
obese patient, 84
190
Index
Sigmoid colectomy (cont.)
operating room set up, 67, 68
operation steps, 66
operation tools, 66, 67
parietal peritoneum plane, 71
patient positioning, 67, 68
pelvic anatomy, 69
port placement, 68
preoperative planning, 66
resection margins, 77
side to end anastomosis, 79, 80
splenic exure mobilization, 75–77
sympathetic and parasympathetic nerves, 72
tension and counter-tension, 73
ureter, 71
ureteral stents, 72
volvulus, 84
wound infection prevention, 80
Single band adhesiolysis, 167
Splenic exure
anterior approach, 53
gastrocolic ligament, 52–55
inferior mesenteric vein, 57
in situ plane between colon and omentum, 54
lateral attachments/line of Toldt, 55
lesser sac, 53
patient and surgeon positioning, 52
retroperitoneal attachments, 56
splenocolic ligament, 55
bowel graspers, 58
bowel retraction, 62
clinical indications, 49
complete mobilization, 62
denition, 49
in situ, 50
lateral attachments/line of Toldt, 56
lateral-to-medial approach
gastrocolic ligament, 59, 60
lateral attachments/line of Toldt, 57–59
splenocolic ligament, 58, 59
lengthening procedures, 63
medial-to-lateral approach
gastrocolic/omental and lateral attachments, 62
medial dissection, 61, 62
operative approaches, 49, 50
operative steps, 50
patient positioning, 51, 52
port placement, 52
spleen, 63
“sub-IMV” approach, 62
Stoma triangle, 122
Subtotal colectomy
Baker anastomosis, 139
bruising, 138
bulky mesentery, 132
clinical indications, 125, 126
colon as retractor, 137
denition, 125
distal transection of rectosigmoid, 138
end ileostomy, 140
hand port, 139
hepatic exure mobilization, 132, 133
ileocolic pedicle division, 131
ileorectal anastomosis, 139
end-to-end anastomosis, 140
side-to-end (Baker) anastomosis, 139
inferior mesenteric artery, 135, 136
laparoscopy, 129
left colon mobilization, 137, 138
lesser sac, 133
middle colic pedicle, 134, 135
mid-mesenteric dissection, 136
omentum, 133
open bowel grasper, 130
operation steps, 126
operation tools, 126
patient positioning, 127–129
patient set up, 129
port placement, 129
preoperative planning, 126
right colon medial to lateral
dissection, 130, 131
specimen extraction, 138
stapling the bowel, 138
table rotation, 129
terminal ileum mobilization, 132
T
T4b tumors, 123
Tools
abdomen accessing, 4
changing ports in the obese/large
patient/tall patient pannus, 7
open Hassan technique, 4
trocars, 6, 7
Veress entry, 4–6
visual entry cannula system, 6
bowel preparation, 1
incisions/ wound protectors, 11, 12
intraoperative endoscopy, 10, 11
lines and tubes, 2, 3
operating room
communication, 1
general approach, 1
preoperative preparation, 1
secondary plan, 1
patient setup, 2
suction-irrigation-cautery device, 9
surgery techniques
bowel graspers, 7, 8
energy instrumentation, 9, 10
running of bowel, 8
wound closure, 12, 13
Transverse colectomy
blood supply, 48
clinical indications, 35
denition, 35
entering the lesser sac, 43
hepatic exure mobilization, 44
Index
191
inferior mesenteric vein, 46
intraoperative staging, 38
medial middle colic vessel ligation, 42
middle colic pedicle, 47, 48
middle colic vessels, 41
Ole procedure, 42
omentum resection, 43, 44
operation steps, 36
operation tools, 36
operative plan determination, 38
pathology, 38
patient positioning, 38
port placement, 38
preoperative planning, 36
resection extent, 38, 40
specimen exteriorization and anastomosis, 48
splenic exure mobilization, 45, 46
splenic exure tumor, 46
tumor localization, 40
V
Veress entry, 4–6
Visual entry cannula system, 6
W
White line of Toldt, 26, 27, 30
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