Advanced Laparoscopic Surgery (eBook)

Dr.N.Katkhouda is a world authority in laparascopic surgery,having pioneered the first laparoscopic vagotomy for th treatment of gastroduodenal ulcer disease. He is an active partner of the USC Bariatric Surgery Program and in his capacity, offers the patients all laparoscopic approaches for weight loss surgery including hand sawn laparocosopic Roux en Y gastric Bypass and Lap Band.

Advanced Laparoscopic Surgery 3
Preface 7
Acknowledgements 9
Contents 11
1 General Concepts 19
The Checklist Approach 19
The Team 19
The Instruments 20
Patient Positioning 21
Setup for Upper Abdominal Surgery 21
Basic Laparoscopic Cholecystectomy 21
Setup for Advanced Upper Abdominal Surgery 21
Setup for Lower Abdominal Surgery 23
The Working Environment 25
Appraisal of Surgical Instruments 27
Trocars 27
Choosing an Appropriate Trocar 27
Disposable Trocars 27
Nondisposable Trocars 28
Optical Viewing Trocars 28
Prevention of Accidents with Trocars 30
Triangulation of Trocars 30
Other Instrumental Requirements 31
Laparoscopes 31
Cameras 32
Creation of the Pneumoperitoneum 32
Troubleshooting Loss of Pneumoperitoneum 33
Principles of Hemostasis 33
Control of Bleeding of Unnamed Vessels 33
Control of Bleeding of a Main Named Vessel 35
Irrigation and Suction Devices 36
Selected Further Reading 37
2 Cholecystectomy 39
Basic Laparoscopic Cholecystectomy 39
Acute Gangrenous Cholecystitis 46
“Dangerous” Cholecystectomy 47
Impacted Stone (Hydrops, Empyema, Early Mirizzi) 47
Avoiding Injury to the Common Bile Duct 50
Controlling Bleeding in the Liver Bed 53
Adhesions Due to Previous Upper Midline Laparotomy 53
Selected Further Reading 55
3 Common Bile Duct Explorations and Bilioenteric Anastomosis 58
The Transcystic Approach 58
The Common Bile Duct Approach 59
Choledochoduodenostomy 61
Hepaticojejunostomy with a Roux-en-Y 61
Selected Further Reading 64
4 Laparoscopic Liver Surgery 66
The Need for Specialized Equipment 66
Positioning the Patient and Operating Team 67
Access to the Liver 67
Maneuvers Common to All Laparoscopic Liver Surgery 70
Diagnostic Laparoscopy 72
Fenestration of Liver Cysts (Fig. 4.6) 72
Resection of Liver Tumors 72
Limited Resection of Minor Lesions 74
Left Lateral Segmentectomy 75
Right Hepatectomy 78
Treatment and Prevention of Perioperative Complications 79
Patient Selection 80
Selected Further Reading 81
5 Esophageal Surgery 83
Nissen Fundoplication 83
Principles of Surgical Therapy in the Management of Gastroesophageal Reflux Disease 83
Patient Positioning 83
Technique 84
Access to the Hiatus 87
Identification of the Left Crus at the Right Side of the Esophagus 87
Creation of a Window Under the Esophagus 87
Division of the Phrenoesophageal Membrane 90
Division of the Short Gastric Vessels 90
Crural Closure and Fundoplication 95
Postoperative Course 96
Management of Complications 97
Bleeding During the Procedure 97
Perforation of the Esophagus 97
Mechanical Problems 98
Toupet Posterior Partial Fundoplication 100
Paraesophageal Hernia 102
Esophageal Myotomy for Achalasia 105
Vagotomies 105
Bilateral Truncal Vagotomy 105
Highly Selective Vagotomy 107
Lesser Curvature Seromyotomy and Posterior Truncal Vagotomy 110
Selected Further Reading 113
6 Gastric Surgery 117
Pyloroplasty 117
Vagotomy with Antrectomy or any Distal Gastrectomy 119
Port Placement 119
Technique 120
Division of the Right Gastroepiploic Artery and Retroduodenal Dissection 122
Intra-abdominal Gastrojejunostomy and Billroth II Reconstruction 123
Laparoscopic Gastrojejunostomy and Roux-en-Y Reconstruction 123
Laparoscopically-Assisted Gastrojejunostomy 125
Perforated Duodenal Ulcer 126
Locating the Perforation 126
Abdominal Washout 128
Closure of the Perforation with an Omental Patch 128
Postoperative Course 129
Selected Further Reading 131
7 Appendectomy 134
Acute Appendicitis 134
OR Setup and Port Placement 134
Technique 137
Endoloop Technique 137
Stapling Technique 137
Gangrenous or Perforated Appendicitis 140
Laparoscopic Assisted Appendectomy 144
Selected Further Reading 145
8 Colorectal Procedures 147
Principles of Laparoscopic Colectomies 147
Right Hemicolectomy 147
Left Hemicolectomy 149
Hartmann Procedure 153
Reversing the Hartmann Procedure 153
Selected Further Reading 155
9 Small Bowel Obstruction 157
Selected Further Reading 161
10 Inguinal Hernia Repair 162
General Considerations and Surgical Anatomy 162
Transabdominal Preperitoneal Repair (TAPP) 166
Patient and Port Positioning 166
Dissection of the Preperitoneal Space 166
Dissection of the Cord Structures and the Vas Deferens 168
Placement of the Mesh and Fixation 168
Closure of the Peritoneum 173
Management of Large Indirect Hernias 175
Totally Preperitoneal Hernia Repair (TEP) 175
Selected Further Reading 179
11 Incisional and Ventral Hernia Repair Including Component Separation 182
Indications 182
Technique 182
Positioning 182
Pneumoperitoneum 183
Port Placement 183
Adhesiolysis 184
Measurement of the Hernia Defect 185
Placement of Mesh 185
Difficult Ventral or Incisional Hernias 190
Pain Following Laparoscopic Ventral or Incisional Hernia Repair 190
Laparoscopic Component Separation 191
Selected Further Reading 193
12 Splenectomy (Total and Partial) and Splenopancreatectomy 194
Classic Laparoscopic Splenectomy 194
Preoperative Requirements and Workup 194
Patient Positioning 195
Port Placement 199
Surgical Anatomy 200
Surgical Principles 201
Anterior Approach 201
Technique 201
Division of the Short Gastric Vessels and Exposure of the Tail of the Pancreas 201
Division of the Hilar Vessels and Phrenic Attachments 203
Extraction of the Spleen in a Bag 203
Final Steps of the Procedure 206
Posterior Approach 206
Post Operative Course 206
Management of Complications 206
Control of an Unnamed Vessel 208
Control of a Major Vessel 208
Splenic Injury 208
Maneuver of Last Resort During Bleeding of the Hilar Vessels 208
Partial Splenectomy 209
Hand Assisted Laparoscopic Splenectomy (HALS) 211
Distal Splenopancreatectomy 212
Selected Further Reading 214
13 Adrenalectomy 216
Principles 216
Left Adrenalectomy 216
Right Adrenalectomy 221
Selected Further Reading 225
14 Bariatric Surgery 227
Laparoscopic Roux-en-Y Gastric Bypass 227
Patient Positioning 229
Technique 229
Immediate Postoperative Complications 247
Bleeding 247
Leak 247
Late Postoperative Complications 248
Internal Hernia 248
Anastomotic Ulcers 251
Stricture 251
Laparoscopic Adjustable Band 251
OR Set Up 251
Technique 251
Complications 256
Slippage 256
Erosion 256
Laparoscopic Sleeve Gastrectomy 261
Selected Further Reading 267
15 Single-Access Laparoscopic Surgery (SALS) 268
Basic Transumbilical Procedures 268
Laparoscopic Cholecystectomy 272
Laparoscopic Appendectomy 272
Laparoscopic Inguinal Hernia Repair 272
Alternative Technique Using Disposable Devices 273
Selected Further Reading 274
16 Advanced Laparoscopic Suturing Techniques 275
Ergonomics of the Operating Room (OR Table Height, Monitor Placement) 275
Monitors 275
OR Table 275
Trocar Placement and Triangulation 276
Equipment 277
Needle Holders 278
Graspers 278
Suture Material 279
Intracorporeal Knot-Tying 279
Interrupted Stitch 279
Running Stitch 280
Pirouette 281
Extracorporeal Knot-Tying 281
Roeder’s Knot 282
Endoloop 283
Troubleshooting 283
Lost Needle 283
Short Suture 283
SelectedFurtherReading 285
Subject Index 286