Lower Gastrointestinal Tract Surgery: Vol.1, Laparoscopic procedures (eBook)
XVI, 690 Seiten
Springer International Publishing (Verlag)
978-3-030-05240-9 (ISBN)
This atlas, containing a wealth of clear operative images, is designed to enable trainee surgeons to visualise the surgical field for procedures specific to laparoscopic colorectal surgery, thereby facilitating understanding and learning of surgical techniques and avoidance of intra- and postoperative complications. Step-by-step guidance is provided for a wide range of procedures employed in patients with benign and malignant tumours, inflammatory bowel disease, diverticular disease, rectal prolapse and other conditions. Examples include right colectomy techniques, sigmoid colectomy, left hemicolectomy, total colectomy, panproctocolectomy, total mesorectal excision, Hartmann's procedure and its reversal and rectopexy. Throughout, meticulous attention is paid to surgical anatomy. Whenever considered necessary, additional line drawings are included to aid comprehension of particular steps in the surgery. Readers seeking to improve their comprehension of surgical anatomy and how to perform these operative procedures will find the atlas to be an unparalleled source of information and assistance. A complementary book from the same authors focuses on open colorectal surgery.
Michael Parker qualified from Westminster Hospital Medical School in 1973. He acquired the FRCS and FRCS(Ed) in 1980 and MS (London) in 1987. A consultant surgeon in a district general hospital for over 20 years with a specialist interest in laparoscopic surgery, Professor Parker is a member of the Court of Examiners of the Royal College of Surgeons of England, past President of the Association of Coloproctology of Great Britain and Ireland, past President of the Surgical Section of the Royal Society of Medicine, past President of the Association of Laparoscopic Surgeons of Great Britain and Ireland, a former Council member of the Royal College of Surgeons of England and a current Trustee of the European Society of Coloproctology. In 2010 he initiated a programme of laparoscopic colorectal training in Denmark and in 2013, after over one hundred visits to Jutland, was conferred with an Honorary Chair from the University of Århus. This training programme is ongoing in Copenhagen and now also in Sweden. The programme has succeeded in raising the incidence of laparoscopic resection of bowel cancer in Denmark to over 90% which equates to the highest in Europe. Long term outcome results are amongst the best in the world.
Werner Hohenberger is Full Professor of Surgery, University of Erlangen-Nuremberg, Germany and Chair of the Surgical Department at the same university, where he obtained his degree in 1973. Beside his long teaching career, during which he also worked as visiting professor in many universities abroad, such as the Cleveland Clinic, Ohio, USA and the Peking University People's Hospital, China, he has been dedicating great efforts within scientific societies in the field of surgical oncology, which remains his chief clinical interest. He was President of the German Cancer Society, the German Cancer Congress and Member of the Executive Committee of the German Senologic Society.
Foreword 6
Preface 7
Acknowledgements 8
Contents 9
Contributors 11
1: The Anatomy of the Small Intestine 13
1.1 Duodenum 20
1.1.1 Vascular Supply, Lymphatic Drainage and Innervation of the Duodenum 24
1.1.1.1 Arteries 24
1.1.1.2 Veins 25
1.1.1.3 Lymphatic Drainage 26
1.1.1.4 Innervation 26
1.2 Jejunum 26
1.3 Ileum 26
1.4 Vascular Supply, Lymphatic Drainage and Innervation of the Small Bowel 26
1.4.1 Arterial Supply 26
1.4.2 Venous Drainage 27
1.4.3 Lymphatic Drainage 27
1.4.4 Innervation 27
References 38
2: The Anatomy of the Large Intestine 39
2.1 Midgut Region of the Large Intestine 44
2.1.1 Ileocolic Junction 44
2.1.2 Caecum 45
2.1.3 Appendix 46
2.1.4 Ascending Colon 48
2.1.5 Hepatic Flexure 49
2.1.6 Transverse Colon 50
2.1.7 Vascular Supply and Lymphatic Drainage of the Midgut 51
2.1.7.1 Arterial Supply 51
2.1.7.2 Venous Drainage 58
2.1.7.3 Lymphatic Drainage 59
2.1.8 Innervation 60
2.2 Hindgut Region of the Large Intestine 66
2.2.1 Splenic Flexure 66
2.2.2 Descending Colon 67
2.2.3 Mesocolon 69
2.2.4 Sigmoid Colon 76
2.2.5 Anorectum: Rectum and Anal Canal 78
2.2.5.1 Rectum 78
2.2.6 Mesorectum and Rectal Fasciae 80
2.2.7 Anal Canal 81
2.2.8 Vascular Supply and Lymphatic Drainage of the Hindgut 85
2.2.8.1 Arterial Supply 85
2.2.8.2 Venous Drainage 91
2.2.8.3 Lymphatic Drainage 93
2.2.9 Innervation 93
References 100
3: Laparoscopic Appendicectomy 102
3.1 Introduction 102
3.2 Anatomical Considerations 102
3.3 Operative Approach: Open Appendicectomy 105
3.3.1 Classic Gridiron Exposure 105
3.3.2 Incision in Peritoneum 107
3.3.3 Devascularisation of the Appendix 108
3.3.4 Burial of the Appendix Stump 108
3.4 Operative Approach: Laparoscopic Appendicectomy 111
3.4.1 Visualisation and Retraction of the Appendix 111
3.4.2 Entering the Avascular Window at the Base of the Mesentery 112
3.4.3 Transection of the Appendix 112
3.4.4 Transection of the Mesoappendix 112
3.4.5 Retrieval of the Appendix 115
3.5 Results 115
3.5.1 Laparoscopic Versus Open Appendicectomy 115
3.5.2 Have Surgical Trends Changed? 116
3.6 Conclusion 117
References 117
4: Laparoscopic Ileostomy and Colostomy for Faecal Diversion 118
4.1 Introduction 118
4.2 Preoperative Considerations 118
4.3 Operative Steps 119
4.3.1 Laparoscopic Loop Ileostomy 119
4.3.1.1 Aqueous Povidone Solution 119
4.3.1.2 Entry Technique and Port Placement 119
4.3.1.3 Locating Terminal Ileum 120
4.3.1.4 Ileal Loop Selection 120
4.3.1.5 Internal Loop Orientation 120
4.3.1.6 Creation of the Stoma Aperture 123
4.3.1.7 External Loop Orientation 125
4.3.1.8 Loop Ileostomy Formation 125
4.4 Laparoscopic End Ileostomy 126
4.5 Laparoscopic End Colostomy 127
4.5.1 Alcoholic Chlorhexidine Solution 127
4.5.2 Entry Technique and Port Placement 128
4.5.3 Dissection and Mobilisation 128
4.5.4 Transection Technique 129
4.5.5 Delivering the Proximal End of Bowel 129
4.5.6 Creation of the Stoma Aperture 130
4.6 Laparoscopic Loop Colostomy 133
4.7 Postoperative Management 133
4.7.1 High-Output Stomas 133
4.7.2 Parastomal Hernia 133
4.7.3 Mucocutaneous Separation 134
4.7.4 Stoma Retraction 134
4.7.5 Stomal Stenosis 134
4.7.6 Peristomal Pyoderma Gangrenosum 134
References 134
5: Oncological Right Colectomy by Laparoscopic Medial-to-Lateral Approach with Total Mesocolic Excision 136
5.1 Technique 136
5.1.1 General Considerations 136
5.1.2 Medial-to-Lateral Dissection: Five Steps 137
5.1.3 Side-to-Side Stapled Ileocolic Anastomosis: Three Steps 146
5.1.4 Essentials 147
5.2 Conclusions 147
References 147
6: Laparoscopic Extended Right Colectomy 149
6.1 Indications 149
6.2 Preoperative Assessment and Preparation 149
6.3 Anaesthesia 149
6.4 Procedure: Key Steps 150
6.5 Patient Positioning 150
6.6 Instrument Positioning 151
6.7 Umbilical Port Insertion 151
6.8 Laparoscopy and Insertion of Remaining Ports 152
6.9 Definitive Laparoscopic Setup 153
6.10 Defining and Dividing the Ileocolic Pedicle 154
6.11 Mobilisation of the Hepatic Flexure 158
6.12 Division of Middle Colic Vessels 162
6.13 Mobilisation of the Ileocaecal Junction 163
6.14 Specimen Extraction 165
6.15 Conclusion 166
7: The Initial Retrocolic Endoscopic Tunnel Approach (IRETA) to a Laparoscopic-Assisted Radical Right Colectomy: A (Modified) Lateral-to-Medial Technique for the Complete Mesocolic Excision of the Right Colon 167
7.1 Introduction 167
7.2 Advantages of the IRETA Technique 168
7.2.1 Aim 169
7.2.2 Objectives 169
7.2.3 Indications 169
7.2.4 Contraindications 169
7.2.5 Operative Theatre Setup 169
7.2.6 Patient Preparation 174
7.2.7 Patient Operative Position 174
7.2.8 Position of the Surgical Team and the Operative Equipment 175
7.2.9 Anaesthesia 175
7.2.10 Port Strategy 175
7.3 Phases of the Operation 188
7.3.1 Phase I: Diagnostic (Exploratory) Laparoscopy 188
7.3.2 Phase II: The Retrocolic Dissection 194
7.3.3 Phase III: Ileocolic Lymphovascular Pedicle Localisation and High Ligation 206
7.3.4 Phase IV: Right Colic Lymphovascular Pedicle Localisation and High Ligation 211
7.3.5 Phase V: Right Branch of Middle Colic/Middle Colic Lymphovascular Pedicle Localisation and High Ligation 214
7.3.6 Phase VI: Detachment of the Gastrocolic Ligament and Takedown of the Hepatic Flexure 222
7.3.7 Phase VII: Lateral Peritoneal Detachment and Extraction of the Mobilised Specimen 222
7.3.8 Phase VIII: Extracorporeal Bowel Resection-Anastomosis and Abdominal Closure 223
7.3.9 Phase IX: Check Laparoscopy 236
7.3.10 Phase X: Examination of the Specimen 242
7.4 Challenges and Solutions 242
7.4.1 Not Entering the Correct Plane in the Retrocolic Space 242
7.4.2 Trouble in Identifying the Ileocolic Pedicle 243
7.4.3 Trouble in Identifying the Middle Colic Pedicle 244
7.4.4 Mesenteric Twist 244
7.4.5 Mesenteric Hernia 244
7.5 Conclusion 244
References 244
8: Laparoscopic Ileocolic/Right Hemicolectomy for Crohn’s Disease 246
8.1 Introduction 246
8.2 Pre Operative Steps 246
8.2.1 Patient Positioning 246
8.2.2 Trocar Positioning 248
8.3 Operative Steps 249
8.4 Results 293
8.5 Complications 293
8.6 Summary 293
References 293
9: Laparoscopic Sigmoid Colectomy for Diverticular Disease 294
9.1 Procedure 294
9.2 Results 313
9.3 Conclusions 315
References 315
10: Laparoscopic Left Hemicolectomy 316
10.1 Introduction 316
10.2 Procedure 317
10.3 Conclusions 333
References 333
11: Laparoscopic Total Colectomy with Ileostomy for Benign Disease 334
11.1 The Technique: Preparation and Port Placement 334
11.2 Division of the Gastrocolic Ligament and the Transverse Mesocolon 334
11.3 The Right Colon 339
11.4 Important Vascular Anatomy on the Right Side 340
11.5 The Left Colon 340
11.6 Bringing Out the Terminal Ileum and Formation of the Ileostomy 343
11.7 Additional Comments on the Procedure 344
11.8 Conclusions 345
12: Laparoscopic Proctocolectomy and Ileoanal J Pouch Anastomosis 346
12.1 Introduction 346
12.2 Operative Steps 347
12.2.1 Patient Positioning and Draping 347
12.2.2 Port Placement 347
12.2.3 Dissection 348
12.2.4 Pouch Formation 358
12.2.5 Formation of Pouch Anal Anastomosis 360
12.3 Postoperative Care 365
12.4 Conclusions 365
References 365
13: Robotic Total Mesorectal Excision 366
13.1 Introduction 366
13.2 The da Vinci® System 366
13.3 Operative Steps 373
13.3.1 Patient Positioning and Draping 373
13.3.2 Port Placement 383
13.3.3 Mobilisation of Left Colon Division of Inferior Mesenteric Vessels
13.3.4 Preparation for Pelvic Dissection 392
13.3.5 Docking of the Robotic Patient-Side Cart 407
13.3.6 Initial Pelvic Dissection 408
13.3.7 Posterior Dissection 409
13.3.8 Right-Side Dissection 410
13.3.9 Anterior Dissection 410
13.3.9.1 Female Patient 423
13.3.9.2 Male Patient 423
13.3.10 Left-Side Dissection 424
13.3.11 Deep Dissection to Muscle Tube 424
13.3.12 Stapling 431
13.3.13 Extraction and Anastomosis 432
13.4 Results 441
13.5 Conclusions 441
References 441
14: Laparoscopic Low Anterior Resection and Total Mesorectal Excision 443
14.1 Preoperative Considerations 443
14.2 Equipment 443
14.3 Patient Positioning and Draping 443
14.4 Port Placement 444
14.5 Operative Steps 445
14.5.1 Step 1: Positioning of Omentum and Small Bowel Retraction of Uterus
14.5.2 Step 2: Initial Dissection and Identification of Retroperitoneal Structures Including Hypogastric Nerves, Left Ureter and Left Gonadal Vessels Lying Under the Sigmoid Mesentery 450
14.5.3 Step 3: Vascular Division 451
14.5.4 Step 4: Medial-to-Lateral Dissection 464
14.5.5 Step 5: Lateral Dissection and Mobilisation of the Descending and Sigmoid Colon 464
14.5.6 Step 6: Pelvic Brim and Dissection into the Peritoneal Reflection 465
14.5.7 Step 7: TME: Laterally and Anteriorly 474
14.5.8 Step 8: Dissecting Mesorectum to Reach the Bowel Wall Stapling the Rectum
14.5.9 Step 9: Splenic Flexure Mobilisation 495
14.5.10 Step 10: Extracting the Specimen 495
14.5.11 Step 11: Anastomosis and Closure 504
14.5.12 Step 12: Ileostomy Formation and Wound Closures 505
14.6 Postoperative Management 518
Recommended Reading 518
15: Transanal Total Mesorectal Excision Assisted by Laparoscopy 519
15.1 Introduction 519
15.2 Indications 520
15.3 Technique 520
15.3.1 Surgery Preparation 521
15.3.1.1 Camera 522
15.3.1.2 Insufflator System 523
15.3.2 Abdominal Part 528
15.3.3 Transanal TME 529
15.3.3.1 Low Rectal Tumours with Perineal Dissection 529
15.3.3.2 Low or Mid Rectal Tumours 530
Mesorectal Dissection 531
Anterior Side 534
Posterior Side 536
Lateral Sides 536
15.3.3.3 High Rectal Tumours 537
15.3.4 Specimen Extraction 538
15.3.4.1 Transanal Extraction 538
15.3.4.2 Transabdominal Extraction 538
15.3.5 Anastomoses 538
15.3.5.1 Hand-Sewn Coloanal Anastomosis 538
15.3.5.2 Stapled Anastomosis 539
15.3.6 Other Considerations 548
References 548
16: Laparoscopic Hartmann’s Procedure 549
16.1 Introduction 549
16.2 Operative Steps 549
16.2.1 Patient Positioning and Draping 549
16.2.2 Port Positioning 549
16.2.3 Lateral Mobilisation of the Colon 549
16.2.4 Medial Dissection and Ligation of Vessels 554
16.2.5 Bowel Resection 555
16.2.6 Colostomy Formation 558
16.2.7 Closure 559
16.3 Results 560
16.4 Conclusion 560
References 560
17: Laparoscopic Reversal of Hartmann’s Procedure 561
17.1 Introduction 561
17.2 Operative Steps 561
17.2.1 Patient Positioning and Draping 561
17.2.2 Mobilisation of the Colostomy and Division of Local Adhesions 561
17.2.3 Division of Adhesions and Assessment of the Rectal Stump 561
17.2.4 Mobilisation of the Left Colon 571
17.2.5 Anastomosis 571
17.2.6 Closure 577
17.3 Results 577
17.4 Conclusion 578
References 578
18: Laparoscopic Ventral Rectopexy for Rectal Prolapse 579
18.1 Operative Steps 580
18.1.1 Patient Position and Draping 580
18.1.2 Port Placement 580
18.1.3 Initial View of the Pelvis 581
18.1.4 Uterine Retraction 581
18.1.5 Sigmoid Retraction 581
18.1.6 Deep Pouch of Douglas 592
18.1.7 Peritoneal Incision 592
18.1.8 Recto-Vaginal Dissection 602
18.1.9 Mesh Preparation 602
18.1.10 Mesh Placement and Fixation to the Rectum 603
18.1.11 Colpopexy 603
18.1.12 Mesh Fixation to Sacral Promontory 616
18.1.13 Peritoneal Closure 616
18.1.14 Neo-pouch of Douglas 616
18.1.15 Uterine and Sigmoid Release and Final View of Pelvis 616
18.2 Results 617
18.2.1 Short-Term Outcomes 617
18.2.2 Functional Outcomes 617
18.2.3 Recurrence 626
18.2.4 Long-Term Complications 626
18.3 Conclusions 626
References 626
19: Laparoscopic Posterior Rectopexy for Rectal Prolapse 627
19.1 Introduction 627
19.2 Operative Steps 627
19.2.1 Patient Position and Draping 627
19.2.2 Port Placement 627
19.2.3 Initial View of the Pelvis 630
19.2.4 Right-Side Peritoneal Incision 630
19.2.5 Posterior Dissection 631
19.2.6 Swab Placed Behind the Rectum 644
19.2.7 View of the Left Side of the Pelvis 644
19.2.8 Left-Side Peritoneal Incision 645
19.2.9 Identification of the Swab and Left Side Dissection 650
19.2.10 View of the Pelvis after Dissection Is Completed 650
19.2.11 Mesh Preparation 651
19.2.12 Mesh Placement 651
19.2.13 Mesh Fixation to the Sacrum 658
19.2.14 Mesh Fixation to the Rectum 658
19.2.15 Trim of the Mesh 659
19.2.16 Final View of the Pelvis 668
19.3 Results 668
19.3.1 Short-Term Outcomes 668
19.3.2 Recurrence 669
19.3.3 Functional Outcomes 669
19.4 Conclusions 669
References 670
20: Laparoscopic Rectal Resection for Endometriosis 671
20.1 Introduction 671
20.2 Indications for Surgery 671
20.3 Operative Steps 671
20.3.1 Port Placements 671
20.3.2 Identifying the Ureters 672
20.3.3 The Ovaries and Salpinges 673
20.3.4 Front of the Rectum 680
20.3.5 Back of the Rectum 681
20.3.6 Dividing the Rectum 685
20.3.7 Removing the Endometriosis Infiltrate 688
20.3.8 The Anastomosis 688
References 698
| Erscheint lt. Verlag | 17.7.2019 |
|---|---|
| Reihe/Serie | Springer Surgery Atlas Series | Springer Surgery Atlas Series |
| Zusatzinfo | XVI, 690 p. 365 illus., 354 illus. in color. |
| Sprache | englisch |
| Themenwelt | Medizin / Pharmazie ► Medizinische Fachgebiete ► Chirurgie |
| Schlagworte | abdominal surgery • Endometriosis • hemicolectomy for cancer • hemicolectomy for Crohn’s Disease • Ileoanal Pouch • Lap appendectomy • Laparoscopic Extended Right Colectomy • mesorectal excision • Oncological Right Colectomy • panproctocolectomy • Sigmoid Colectomy for Diverticular Disease • surgical oncology • total colectomy for IBD • Total Mesocolic Excision • Trans-anal Total Meso-rectal Excision • trauma surgery • Ventral Rectopexy for Rectal Prolapse |
| ISBN-10 | 3-030-05240-0 / 3030052400 |
| ISBN-13 | 978-3-030-05240-9 / 9783030052409 |
| Haben Sie eine Frage zum Produkt? |
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