BookSharon L. Stein, Regan R. Lawson, editors.
Summary: This book is designed specifically to help equip new surgeons with the anatomical and technical knowledge to supplement hands on experience in minimally invasive colon and rectal surgery. There are multiple colorectal surgeries which distinctly lend themselves to the use of the laparoscopic approach. To assist the junior surgeon who is embarking on a career in surgery, expert surgeons and educators in the field of colon and rectal surgery from around the country authored the chapters included in this book. Chapters describe key elements of each surgery, including the order of surgery, when and how the surgeon created tension, rotated the patient, and optimized flow of the surgery. Chapters also contain tips and pitfalls that are not always explicitly presented when describing a surgical approach in order to provide readers with a diverse toolkit. Each chapter is also full of new illustrations that show the direction of traction, the line of dissection, and the anatomy of the colon. The illustrations also present tools in a color-coded format to clearly distinguish between the surgeons and the assistants tools. Laparoscopic Colectomy: A Step by Step Guide is a valuable resource to residents and junior attendings who wish to master laparoscopic colon and rectal surgery.
Contents:
Intro
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