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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1419_Библиотеки_им_академика_М_И_Перельмана.pdf
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- •Foreword
- •Preface
- •Acknowledgments
- •Contents
- •Procedure
- •Result
- •Concluding Remarks
- •References
- •Contributors
- •Biography
- •Surgical Staff
- •Theory Preparation
- •Laboratory
- •Robotic Setup
- •Introduction
- •Operating Room (OR) Setup
- •Robotic Docking
- •Getting Started
- •Summary
- •Concluding Remarks
- •Glossary [15]
- •References
- •Introduction
- •Anatomy
- •Background
- •Single-Dock Retromuscular Repair
- •Double-Dock Retromuscular Repair
- •Preperitoneal Repair
- •Intraperitoneal Repair
- •Summary
- •Concluding Remarks
- •Glossary
- •References
- •Introduction
- •Techniques
- •Instrumentation
- •Essential Steps
- •Adhesiolysis
- •Robotic TAPP Ventral Hernia Repair
- •Essential Steps
- •Suprapubic Hernias
- •Essential Steps
- •Summary
- •Concluding Remarks
- •References
- •Introduction
- •Robotic Transabdominal Preperitoneal (rTAPP) Hernia Repair
- •Surgical Anatomy
- •Preoperative Considerations
- •Robotic Transversus Abdominis Release (ROBOTAR)
- •Preoperative Considerations
- •Posterior Sheath Mobilization
- •Transversus Abdominis Release
- •Contralateral Dissection
- •Concluding Remarks
- •Glossary
- •References
- •Introduction
- •Problem Evaluation
- •Operative Technique
- •Parastomal
- •Adhesiolysis
- •Mesh Repair
- •Lateral Defects
- •Adhesiolysis
- •Mesh Repair
- •Summary
- •Concluding Remarks
- •References
- •Pelvic Defects
- •Introduction
- •Preoperative Workup
- •Getting Started
- •Docking
- •Surgical Technique
- •Dissection/Adhesiolysis
- •Complications
- •Summary
- •Concluding Remarks
- •Glossary
- •References
- •Postoperative Pain
- •Introduction
- •Postoperative Pain
- •Pneumoperitoneum
- •Deep Neuromuscular Block
- •Chronic Pain
- •Treatment
- •Multimodal Analgesia
- •Regional Anesthesia
- •TAP Block
- •Approach Considerations
- •Quadratus Lumborum Block
- •Concluding Remarks
- •Glossary
- •References
- •Introduction
- •Conclusions
- •References
- •Introduction
- •Surgical Technique
- •Summary
- •Concluding Remarks
- •Concluding Remarks
- •References
- •Meshes
- •Absorbable Versus Nonabsorbable
- •Tensile Strength
- •Multifilament Versus Monofilament
- •Tissue Reactivity
- •Concluding Remarks
- •Glossary
- •References
- •Molecular Biology
- •Introduction
- •Restoring or Rehabilitating
- •Concluding Remarks
- •References
- •Introduction
- •Respiratory Changes
- •Renal Changes
- •Cardiovascular Changes
- •Splanchnic Changes
- •Positioning
- •Trendelenburg Position (Head Down)
- •Reverse Trendelenburg Position (Head up)
- •Prostatectomy
- •Intra-Abdominal Procedures
- •Thoracic Surgery
- •Transoral Surgery
- •Complications
- •Concluding Remarks
- •References
- •Index

Robotic Surgery
for Abdominal
Wall Hernia Repair
A Manual of
Best Practices
Ricardo Z. Abdalla
Thiago Nogueira Costa
Editors
123

Robotic Surgery for Abdominal Wall
Hernia Repair

Ricardo Z. Abdalla • Thiago Nogueira Costa
Editors
Robotic Surgery for
Abdominal Wall Hernia
Repair
A Manual of Best Practices

Editors
Ricardo Z. Abdalla
Department of Gastroenterology
University of São Paulo School of Medicine
São Paulo, Brazil
Sao Paulo Cancer Institute at University
of Sao Paulo
São Paulo, Brazil
Thiago Nogueira Costa
Department of Gastroenterology
University of São Paulo School of Medicine
São Paulo, Brazil
Sao Paulo Cancer Institute at University
of Sao Paulo
São Paulo, Brazil
ISBN 978-3-319-55526-3 ISBN 978-3-319-55527-0 (eBook)
DOI 10.1007/978-3-319-55527-0
Library of Congress Control Number: 2017954916
© Springer International Publishing AG 2018
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar
methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specic statement, that such names are exempt from the
relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, express or implied, with respect to the material contained herein or for any errors
or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims
in published maps and institutional afliations.
Printed on acid-free paper
This Springer imprint is published by Springer Nature
The registered company is Springer International Publishing AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Foreword
Surgeons owe it to their patients to optimize their skill sets by staying up to date
with emerging hernia repair techniques that may enhance outcomes. Surgeons
should avoid thinking that one repair is good for all hernias and instead strive to
learn new techniques to broaden the scope of what they can offer patients.
The rise of robotic instruments and platforms to assist in the repair of all types of
hernias is upon us, achieving global penetration. Much of this rise in general surgery
is secondary to a popular explosion of robotics in hernia repair. A true visionary, Dr.
Ricardo Abdalla, performed some of the very rst robotic hernia repairs in the
world, and as such he has also started one of the rst robotics programs at his hospital. To share what he has learned with the world, he has successfully gathered
some of the most pioneering robotic hernia surgeons from various countries to compile a comprehensive overview of robotic-assisted hernia repairs and general surgery procedures.
This book is essential for any surgeon who wishes to begin or to enhance their
robotic hernia experience. From learning how to start a robotic program and training
to learning expected short- and long-term outcomes following robotic incisional
hernia repairs, Dr. Abdalla’s book successfully teaches how to perform every different hernia operation.
I have had the privilege of learning directly from Dr. Abdalla, but now through
the chapters in this book, all surgeons wishing to embark into the world of robotic
surgery can learn from him and his colleagues as well. A true robotic surgeon must
have this on his or her shelf!
New York City, NY, USA BrianJacob
v

Preface
“Technology happens, it’s not good, it’s not bad. Is steel good or bad?” It is a question of
when barriers to the adoption of technology will be circumvented not whether it will happen.
Technology itself is morally agnostic. “I think that technologies are morally neutral until we
apply them. It’s only when we use them for good or for evil that they become good or evil.”
Andrew S.Grove, former President and CEO of Intel Corporation (1997)
The abdominal wall is a very wide part of the human body and one of its most
prevalent problems are abdominal hernias. Although these conditions are common
and taken for granted, they tend to cause major problems in the daily routine of the
patient and in their overall treatment.
The main therapy for them is the surgical method, but there is a lack of standardization regarding the type of procedure, localization of the problem, size of hernia,
classication, and even the approach. With the improving surgical technology novel
techniques started to appear and gain space such as laparoscopy. It is very difcult
and challenging to consider or understand when a minimally invasive procedure
will help, get rid of, or facilitate this problem solution. These procedures are sometimes bogged down due to the instruments’ movement limitations, two-dimensional
view, and patients’/surgeons’ positioning. There is a long list of restrictions in some
procedures that could be cleared as we apply new facilities in diagnosis and preparation to preoperative issues. Robotic technology can overcome these problems in a way
that new techniques could be developed and complex hernias could be treated by
minimally invasive procedures, which was unthinkable. Fundamentals are the same.
The rst step is to be familiar with the robot and its development history. That will
change a lot in the near future and we need to be prepared.
However, because robotic surgery has emerged only recently in the hernia eld,
there are few standardizations regarding techniques, approaches, and overall setup.
Robotic Surgery for Abdominal Wall Hernia Repair intends to be a guide for surgeons who want to use this evolving method in the treatment of such a prevalent
disease. This book is composed mainly of three parts: how to build a robotic hernia
center, how to do the procedures, and the other components such as herniosis and
technical issues.
In this practical guide we invited experts in robotic hernia repair and surgical
leaders to explain the best way to organize a center in all ways, including training,
setup, and procedures. The abdominal wall and the trunk were imagined as one
vii

viii
Preface
individualized compartment. We divided the hernias by location and complexity,
and each of them is explained step by step by specialists in the area from around the
world, using gures and drawings. And most of all, we didn’t forget associated
concerns such as quality of life, anesthesia, pain management, meshes, and adhesions.
Surgical practitioners who want to perform in the world with expanding technology
have to be guided to facilitate their path and Robotic Surgery for Abdominal Wall
Hernia Repair: A Manual of Best Practice is a great way to do so in the hernia eld.
Sao Paulo, Brazil RicardoZ.Abdalla
ThiagoNogueiraCosta

Acknowledgments
University of São Paulo
Cancer Institute State of São Paulo– ICESP
Medical School of the University of São Paulo
Ivan Cecconello
Ulysses Ribeiro
Silvia Kobayashi
Evelise Pelegrinelli Zaidan
Clinic Engineering of ICESP
Springer
ix

Contents
Preparing aRobotic Program andSurgeon Training Regimen
forHernia andAbdominal Wall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Ivan Cecconello and Evelise Pelegrinelli Zaidan
Robotic Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Thiago Nogueira Costa
Robotic Repair ofUpper Abdominal Hernias . . . . . . . . . . . . . . . . . . . . . . . 21
Jeremy A. Warren and Alfredo M. Carbonell
Robotic Repair ofLower Abdomen Defects . . . . . . . . . . . . . . . . . . . . . . . . . 35
Eduardo ParraDavila, Flavio Malcher, and Carlos Hartmann
Robotic Ventral Hernia Repair fromaLateral Approach . . . . . . . . . . . . . 49
Conrad Ballecer, Daniela Cocco, and Brian Prebil
Parastomal andLateral Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Ricardo Z. Abdalla, Thiago Nogueira Costa,
and Cassio Eduardo Silva Gontijo
Pelvic Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Thiago Nogueira Costa and Ricardo Z. Abdalla
Postoperative Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Pedro Paulo Kimachi and Elaine GomesMartins
Quality ofLife . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Ulysses Ribeiro Jr., Silvia Takanohashi Kobayashi,
and Alessandro Gonçalves Campolina
Anatomical Dissection forAdhesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Ricardo Z. Abdalla and Danniel Frade Said
Miscellaneous: Meshes andSutures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Marcelo Furtado
xi

xii
Contents
Molecular Biology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Renato MirandadeMelo
Anesthesia forRobotic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Claudia Marquez Simões
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
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