Preface
Acknowledgments
Contents
Contributors
About the Editors
Content Editor and Contributing Author
Educational Editor
1: Tools
Introduction
Preoperative Preparation
Bowel Prep
Patient Setup
Lines and Tubes
Accessing the Abdomen
Open Hassan Technique
Veress Entry
Visual Entry System
Trocars
Changing Ports in the Obese/Large Patient/Tall Patient/Redundant Pannus
Techniques for Surgery
Types of Bowel Graspers
Running of the Bowel
Energy Instrumentation
Intraoperative Endoscopy
Endoscopy
Wound Protectors
Incisions/Wound Protectors
Wound Closure
2: Laparoscopic Right Colectomy
Introduction
Patient Positioning for Laparoscopic Laparoscopic Right Colectomy
Operative Strategy
Step 1: Port Placement
Step 2: Laparoscopic Staging (if Indicated) and Restoration of Normal Anatomy
Step 3: Identification of Pathology
Step 4: Identification and Transection of the Ileocolic Pedicle
Step 5: Dissection of the Retroperitoneal Plane
Step 6: Identification and Transection of the Middle Colic Arteries (MCA)
Step 7: Transverse Colon Mesenteric Transection
Step 8: Entry into the Lesser Sac
Step 9: Hepatic Flexure Mobilization
Step 10: Lateral Mobilization
Step 11: Attachments to the Terminal Ileum
Step 12: Externalization of Specimen
Step 13: Anastomosis
Step 14: Closure
Special Considerations
Varying the Approach
Top-Down Approach
Bottom-Up Approach
A Lateral to Medial Approach
Crohn’s Disease
Intracorporeal Anastomosis
Steps of Intracorporeal Anastomosis
Preparation of the Colon and Small Bowel (Fig. 2.12)
Transection of the Colon and Small Bowel
Placement of Stabilizing Suture (Stay Suture)
Creation of Enterotomy
Stapling of the Anastomosis
Suturing the Common Enterotomy
3: Laparoscopic Transverse Colectomy
Introduction
Patient Positioning for Laparoscopic Laparoscopic Transverse Colectomy
Operative Strategy
Step 1: Port Placement (Fig. 3.1)
Step 2: Intraoperative Staging
Step 3: Identification of Pathology and Determination of Operative Plan
Step 4: Extent of Resection
Step 5. Continuation of the Right Colectomy: Middle Colic Vessels
Step 6: Medial Middle Colic Vessel Ligation
Step 7: Top-Down Approach: Entering the Lesser Sac
Step 8: Omental Resection
Step 9: Hepatic Flexure Mobilization
Step 10: Splenic Flexure Mobilization
Step 11: Transection of the Inferior Mesenteric Vein (IMV) and Ascending Branch of the Left Colic Artery for Splenic Flexure Tumor
Step 12: Identification and Transection of the Middle Colic Pedicle, Top-Down Approach
Step 13: Specimen Exteriorization and Anastomosis
4: Splenic Flexure
Introduction
Indications
Operative Approaches
Operative Steps
Patient Positioning for Laparoscopic Splenic Flexure
Operative Strategy
Anterior (Lesser Sac) Approach (Fig. 4.2)
Patient and Surgeon Positioning
Step 1: Gastrocolic Ligament
Step 2: Splenocolic Ligament
Step 3: Lateral Attachments/Line of Toldt
Step 4: Retroperitoneal Attachments
Step 5: Inferior Mesenteric Vein (Optional)
Lateral-to-Medial Approach (Fig. 4.9)
Step 1: Lateral Attachments/Line of Toldt
Step 2: Splenocolic Ligament
Step 3: Gastrocolic Ligament
Medial-to-Lateral Approach (Fig. 4.11)
Step 1: Medial Dissection
Step 2: Gastrocolic/Omental and Lateral Attachments
Variation: Sub-IMV Approach
How to Tell When the Splenic Flexure Is Completely Mobilized
Lengthening Procedures
5: Laparoscopic Sigmoid/Left Colectomy
Introduction
Patient Positioning for Laparoscopic Laparoscopic Sigmoid/Left Colectomy
Operative Strategy
Step 1: Port Placement
Step 2: Diagnostic Laparoscopy
Step 3: Identification of the Inferior Mesenteric Artery
Step 4: Identification of the Proper Retroperitoneal Plane
Step 5: Identification of the Ureter and Other Vital Structures
Step 6: Transection of the IMA Pedicle
Step 7: Development of the Retroperitoneal Plane via Medial-to-Lateral Dissection
Step 8: Transection of the IMV Pedicle (if Needed)
Step 9: Lateral Attachment Release
Step 10: Splenic Flexure Mobilization (if Necessary)
Step 11: Distal Transection
Step 12: Extraction and Proximal Transection
Step 13: Anastomosis and Intraoperative Leak Testing
Step 14: Closure
Special Considerations
Alternative Approaches
Fistula/Phlegmon in Diverticular Disease
Volvulus
Laparoscopic Hartmann’s
Obese Patient
6: Laparoscopic Proctectomy
Introduction
Patient Positioning for Laparoscopic Laparoscopic Proctectomy
Operative Strategy
Step 1: Port Placement (Fig. 6.1)
Step 2: Staging Laparoscopy (For Neoplastic Disease If Indicated)
Step 3: Identification of Pathology
Step 4: Creation of the Retroperitoneal Plane
Step 5: Identification of Inferior Mesenteric Artery (IMA) and Left Ureter, with High Ligation of IMA
Step 6: Inferior Mesenteric Vein (IMV) Ligation
Step 7: Mobilization of the Sigmoid and Descending Colon
Step 8: Splenic Flexure Mobilization
Step 9: Rectum Mobilized for Appropriate Resection Margins
Step 10: Rectal Transection
Step 11: Colon Exteriorized and Specimen Resected
Step 12: Anastomosis
Step 13: Formation of Loop Ileostomy (If Indicated)
Step 14: Closure
Special Considerations
Hand-Assisted Laparoscopic Surgery (HALS)
Types of Colorectal and Coloanal Anastomoses (Fig. 6.17)
Hand-Sewn Coloanal Anastomosis
7: Abdominal Perineal Resection
Introduction
Patient Positioning for Laparoscopic Abdominal Perineal Resection
Operative Strategy
Step 1: Port Placement
Step 2: Assess for Metastatic Disease
Step 3: Restore Anatomy
Step 4: Expose the Inferior Mesenteric Artery (IMA) and Ureter Identification
Step 5: Inferior Mesenteric Artery and Vein Division
Step 6: Mobilization of the Left Colon
Step 7: Total Mesorectal Excision
Step 8: Division of Mesocolon and Sigmoid Colon
Step 9: Omental Pedicle Flap
Step 10: Colostomy Creation and Closure
Step 11: Perineal Dissection
Special Considerations
Preoperative Stoma Marking
Varying the Approach
Prone Dissection
T4b Tumors
Intra-levator Dissection
8: Subtotal Colectomy
Introduction
Patient Positioning for Laparoscopic Subtotal Colectomy
Step 1: Port Placement
Step 2: Laparoscopy, If Applicable
Step 3: Right Colon Medial to Lateral Dissection
Step 4: Division of the Ileocolic Pedicle
Step 5: Mobilization of Terminal Ileum
Step 6: Mobilization of the Hepatic Flexure
Step 7: Entry into the Lesser Sac
Step 8: Identification and Division of Middle Colic Pedicle
Step 9: Inferior Mesenteric Artery (IMA)
Step 10: Left Colon Mobilization
Step 11: Distal Transection of the Rectosigmoid
Step 12: Extraction of the Specimen
Step 13: Ileorectal Anastomosis (Side to End (Baker Type) or End to End)
Side-to-End (Baker) Anastomosis (Tip 8.13)
End-to-End Anastomosis
Step 14: Creation of an End Ileostomy (If Necessary)
9: Laparoscopic Proctocolectomy with the Construction of an Ileal Pouch-Anal Anastomosis
Introduction
Patient Positioning for Laparoscopic Laparoscopic Proctocolectomy with the Construction of an Ileal Pouch-Anal Anastomosis
Operative Strategy
Step 1: Port Placement (Fig. 9.1)
Step 2: Initial Inspection of the Peritoneal Cavity
Step 3: Right Colectomy – Posterior Approach
Step 4: Hepatic Flexure
Step 5: Left Colectomy
Step 6: Transverse Colectomy/Splenic Flexure Mobilization
Step 7: Externalize the Colectomy Specimen (Optional)
Step 8: Proctectomy
Step 9: Transection of the Rectum
Step 10: Externalize the Specimen
Step 11: Construction of the Pouch
Step 12: Construction of the Pouch-Anal Anastomosis
Step 13: Creation of Diverting Loop Ileostomy
10: Laparoscopic Lysis of Adhesions and Bowel Obstruction
Introduction
Patient Positioning for Laparoscopic Laparoscopic Lysis of Adhesions and Bowel Obstruction
Operative Strategy
Step 1: Peritoneal Entry
Step 2: Initial Inspection and Port Placement
Right Side Adhesions
Alternative Technique for Dense Adhesions
Step 3: Lysis of Adhesions
Step 4: Running the Bowel
Step 5: Repair of Serosotomy
Step 6: Conversion to Open Surgery
Special Considerations
Single Band Adhesiolysis
Closed-Loop Obstruction
Meckel’s Diverticulum
Crohn’s Disease
Neoplasm
11: Complications
Introduction
Entry Complications
The Complication: Bowel Injury During Entry into the Abdomen
Prevention of the Complication
Recognition of the Complication
Treatment of the Complication
The Complication: Bleeding from Abdominal Vessels During Entry
Prevention of the Complication
Recognition of the Complication
Treatment of the Complication
The Complication: Bleeding from Abdominal Wall Vessels During Port Placement
Prevention of the Complication
Recognition of the Complication
Treatment of the Complication
Complications During Dissection
Bleeding
The Complication: Injury to a Mesenteric Vessel During Ligation and Division
Prevention of the Complication
Recognition of the Complication
Treatment of the Complication
The Complication: Bleeding Secondary to Excessive Retraction or Force
Prevention of the Complication
Recognition of the Complication
Treatment of the Complication
The Complication: Presacral Bleeding During Proctectomy
Prevention of the Complication
Recognition of the Complication
Treatment of the Complication
Complication: Injury to the Bowel
Prevention of the Complication
Recognition of the Complication
Treatment of the Complication
Injury to the Ureter
Prevention of the Complication
Recognition of the Complication
Treatment of the Complication
Splenic Injury
Prevention of the Complication
Identification of the Complication
Treatment of the Complication
Index