Atlas of Laparoscopic Surgery PDF
Preview Atlas of Laparoscopic Surgery
Atlas o f • Laparoscopic Surgery Atlas of Laparoscopic Surgery Theodore N. Pappas Pro/es 0/ rgel] 01' 11 Chief, urgical eJVices urbam VA Medical enler Duke · niver ilJ Mee/ical enler Duke niver i(y MedicClI chool Durham. orlh CCiroliJ1C1 Lewis B. Schwartz A si tanl Professor Department 0/ /Irgel)' Pritzker cboolofMedicille niver ilJ of Cbicago Cbicago lilinois Steve Eubanks A iSlam Profe sor of rgel]' l/ Direclor if urgical Endoscop) Duke nivel ilJ' illedicClI enler Duke niversifJ' Ifee/ical cbool Durham. Vorlh Carolil1Cl With 36 contributors Springer-Science+ßusiness Media, LLC CURRENT MEDICINE 400 MARKET STREET SUITE 700 PHILADELPHIA, PA 19106 MANAGING EDITOR: Lori Bainbridge DEVELOPMENT EDITOR: Elise M. Paxson ART DIRECTOR: Paul Fennessy DESIGN AND LAyOUT: Robert LeBrnn and Lisa Caro ILLUSTRATION DIRECTOR: Ann Saydlowski ILLUSTRATORS: Christopher Burke, Rob Gordon, Claudia Grosz, Nancy Kaplan, Tanya Leonello, Sarah McQueen, fames Perkins, and Susan Tanner INDEXER: AnnBlum PRODUCTION: David Myers and Lori Holland TYPESETTING DIRECTOR: Colleen Ward Atlas of laparoscopic surgery / [edited by] Theodore N. Pappas, Lewis B. Schwartz, Steve Eubanks; with 36 contributors. p. cm. Includes bibliographical references and index. 1. Endoscopic surgery--Atlases. I. Pappas, Theodore N., 1955- . 11. Schwartz, Lewis B., 1960- . III. Eubanks, Steve, 1959- . [DNLM: 1. Surgery, Laparoscopic--methods--atlases. WO 517 A8798 1996] RD33.53.A86 1996 617' .05--dc20 DNLM/DLC for Library of Congress 95-41439 CIP ISBN 978-1-4757-9318-5 ISBN 978-1-4757-9316-1 (eBook) DOI 10.1007/978-1-4757-9316-1 54321 Copyright 1996 by Springer Science+Business Media New York Originally published by Current Medicine in 1966. Softcover reprint ofthe hardcover 1st edition 1966 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise, without prior written permission of the publisher. Fo~e\No~d The field of laparoscopic surgery has progressed at an setting, a number of new procedures have been devised astonishing pace, and new techniques are continuously and evaluated. The center also has an excellent surveil being devised. The impetus for the widespread applica lance plan for outcome studies of patients undergoing tion of this method was initiated by Mouret in 1987 in his laparoscopic procedures. This combination of facilities performance of cholecystectomy by the laparoscopic and services has led to significant advances as weIl as a approach. The great majority of gallbladders are now thorough follow-up of a number of clinical series. . being removed by laparoscopic cholecystectomy with The Atlas 0/ Laparoscopic Surgery is composed of 28 quite favorable results. chapters with authoritative commentaries and illustrations It is generally agreed that the laparoscopic approach for of a number of surgical procedures amenable to laparo many surgical procedures is less invasive, produces less scopic techniques. The chapters are effectively planned, trauma to tissues and organs, is associated with less post with a thorough discussion of the procedure with the operative discomfort, and is accompanied by a more rapid appropriate anatomical, pathophysiological, and differential return of the patient to normal. Moreover, while the diagnostic features. The surgical techniques are graphically instrumentation and equipment used in laparoscopic depicted by a combination of intra operative illustrations procedures are often individualized and more expensive, and selected photographs. The legends accompanying each recent studies have shown that this approach can be cost of the illustrations provide an unusually clear description of effective in comparison with standard open surgical proce each step during the procedure in what is essentially a fail dures, and especially with the short hospital stay. safe approach. A selected bibliography follows each The authors of this text have primarily drawn from their chapter with the most pertinent citations from the literature. experiences in laparoscopic surgery at the Duke-US Occasionally a new text appears which makes such a Surgical Endosurgical Center at the Duke University convincing impression that a prediction can be made with Medical Center. This is the site of considerable develop confidence. This Atlas 0/ Laparoscopic Surgery is a perfect mental research on innovative instrumentation and studies example, as it is composed of a host of procedures that can to devise and assess new procedures. The center is fully be effectively achieved by laparoscopy. It is a masterwork equipped with the la test technology available. In addition by talented contributors and is a must for all those involved there is a vivarium that has an experimental surgical unit in the field. and facilities for long-term postoperative care. In this David C. Sabiston, Ir, MD v PI""eface The Atlas of Laparoscopic Surgery represents the cumula does not have broad application, the technique as it is tive thoughts of a group of surgeons, predominantly from described in this chapter has proven successful in our Duke University Medical Center, in the early 1990s. Our hope experience. The fields of laparoscopie appendectomy and is to capture some of the nuances of laparoscopic surgery laparoscopic herniorrhaphy continue to be quite con that we experienced early in the development of advanced tentious, but the techniques presented in these chapters laparoscopy. The Editors fully realize that the information should be helpful if the readers choose to include these presented will undergo changes over the next several years operations in their surgical repertoire. The chapter on as the field of advanced laparoscopy matures. pediatrie endosurgery is meant mostly as an overview, and We have chosen the word "laparoscopie" in the title of the Editors recognize that entire texts have been devoted this book as a generic term to include both laparoscopy to this subject. and thoracoscopy. The text will probably be most benefi The Editors would like to thank Dr. David C. Sabiston, dal for the minimally invasive general surgeon who occa Jr, for his foreword and for his great support in the devel sionally does thoracoscopie work. The authors have made opment of endosurgery at Duke University Medieal Center. an effort to include alternative techniques to the ones that Dr. William C. Meyers is a contributor to this atlas and is are frequently used at Duke. The Editors acknowledge also the driving academie force behind most of our endo that there are many ways to successfully complete most surgical innovations. Finally, the Editors would like to operations, and where a single technique is presented, thank Leon Hirsch and the US Surgical Corporation for many other techniques could be substituted. We find that their philanthropie support of the Department of Surgery the techniques described are effective and usually quite at Duke Hospital in our efforts to advance the surgical safe. Efforts have been made to include techniques that knowledge of endosurgery. are widely applicable for most advanced laparoscopic Our sincere hope is that this atlas will simplify and orga surgeons, and given the choiee between complex versus nize surgieal thought for the advanced laparoscopist. The simple techniques, we tend to use the least complex and operations described should be safe, should not require shortest operation. Many of the operations, such as the extensive operating time, and should be effective for the laparoscopic antireflux procedures and laparoscopic diseases described. gastrostomy and jejunostomy, are spedfically detailed to Tbeodore N. Pappas reduce the learning curve for these procedures as much as Lewis B. Schwartz possible. Although laparoscopic cholecystojejunostomy Steve Eubanks VI Hartmuth B. Bittner, MD, PhD John P. Grant, MD Senior Assistant Resident Professor Department ofS urgery Department ofS urgery Duke University Medical Center Duke University Medical Center Durham, North Carolina Duke University Medical School Durham, North Carolina Gene D. Branum, MD Assistant Professor David H. Harpole, Jr, MD Department ofS urgery Assistant Professor Emory University School ofM edicine Division of 1boracic Surgery Emory University Hospital and VA Medical Center Haroard Medical School Atlanta, Georgia Boston, Massachusetts Ravi S. Chari, MD Scott H. Johnson, MD Chief Resident Assistant Professor ofS urgery Department ofS urgery Division of Cardiothoracic Surgery Duke University Medical Center Washington University School ofM edicine Duke University Medical School Christian Northeast Hospital Durham, North Carolina St. Louis, Missouri Christine A. Cheng, MD Kevin P. Landolfo, MD Resident in Plastic and Reconstructive Surgery Assistant Professor ofS urgery University of Utah Medical Center Department of Surgery Salt Lake City, Utah Duke University Medical Center Durham, North Carolina Bryan M. Clary, MD Senior Assistant Resident Henry L Laws, MD Duke University Medical Center Director ofS urgical Education Durham, North Caro/ina Carraway Methodist Medical Center Clinical Professor of Surgery Bradley H. Collins, MD University ofA labama School ofM edicine Senior Assistant Resident Birmingham, Alabama Department of Surgery Duke University Medical Center H. K.im. Lyerly, BS, MD Durham, North Carolina Associate Professor, General and 1boracic Surgery Assistant Professor ofP athology Thomas A. D'Amico, MD Assistant Professor of Immunology Fellow in Cardiothoracic Surgery Duke University Medical Center Department of Cardiothoracic Surgery Duke University Medical School Duke University Medical Center Durham, North Carolina Durham, North Carolina Samuel M. Mahaffey, MD Andrew M. Davidoff, MD Assistant Professor Fellow Department ofS urgery Department of Surgery Duke University Medical Center University of Pennsylvania Duke University Medical School Children 's Hospital of Philadelphia Durham, North Carolina Philadelphia, Pennsylvania James R. Mault, MD James M. Douglas,Jr, MD Fellow in Cardiothoracic Surgery Director of Cardiovascular Surgery Department ofS urgery St. joseph Hospital Duke University Medical Center Bellingham, Washington Durham, North Carolina Steve Eubanks, MD Cary H. Meyers, MD Assistant Professor ofS urgery Director of Surgical Endoscopy Chief Resident in Surgery Duke University Medical Center Department of Surgery Duke University Medical School Duke University Medical Center Durham, North Carolina Durham, North Carolina vii WUliam C. Meyers, MD R. Lawrence Reed n, MD Professor of Surgery Associate Professor of Surgery and Anesthesiology Department of Surgery Department of Surgery Duke University Medical Center Duke University Medical Center Duke University Medical School Duke University Medical School Durham, North Caro/ina Durham, North Caro/ina SeanJ. Mulvihill, MD Cary N. Robertson, MD Associate Professor Associate Professor Department of Surgery Division of Urology University of Calijornia, San Francisco, Department of Surgery School ofM edicine Duke University Medical Center San Francisco, Calijornia Durham, North Carolina Lucian Newman m, MD David C. Sabiston, Jr, MD Gadsden RegionallRiveroiew Regional fames B. Duke Professor of Surgery and Chief ofS taJf Gadsden, Alabama Duke University Medical Center Duke University Medical School Keith T. Oldham, MD Durham, North Carolina Professor Department of Surgery and Pediatrics Lewis B. Schwartz, MD Duke University Medical School Assistant Professor Duke University Medical Center Department ofS urgery Durham, North Carolina Pritzker School ofM edicine University of Chicago Theodore N. Pappas, MD Chicago, I//inois Professor of Surgery Chief, Surgical Seroices Phillip P. Shadduck, MD Durham VA Medical Center Consultant Duke University Medical Center Department of Surgery Duke University Medical School Duke University Medical Center Durham, North Caro/ina Attending Surgeon Durham Regional Hospital Marco G. Patti, MD Attending Surgeon Assistant Professor Durham Veterans Administration Hospital Department of Surgery Durham, North Caro/ina University of Calijornia, San Francisco, School ofM edicine John T. Soper, MD San Francisco, Calijornia Professor Department of Obstetrics and Gynecology Jeffrey C. Pence, MD Duke University Medical Center Chief Resident Duke University Medical School General and 1boracic Surgery Durham, North Caro/ina Duke University Medical Center Durham, North Caro/ina James D. St. Louis, MD Senior Assistant Resident WUliam N. Peugh, MD, D.PhU Department ofS urgery C/inical Assistant Professor of Surgery Duke University Medical Center University of Nevada Duke University Medical School Las Vegas, Nevada Durham, North Caro/ina David T. Prlce, BS, MD Christopher R. Watters, MD Resident in Urology Executive Surgical Center, Inc. Division of Urology Raleigh, North Caro/ina Department of Surgery Duke University Medical Center Durham, North Caro/ina viii Co~te~ts 1. Lapa .... oscopic JV\st. ... I.,u't\eV\tatioV\ aV\d Basic TechV\iqi.l\es Thomas A. D'Amico Lewts B. Scbwartz Steve Eubanks The Operating Room .. ... ................................................... 1.2 Imaging Systems ............................................. .. .............1 .2 Laparoscopes ......................... . ................................... 1.2 Light Source ............................. .. ........... .. .... . . . ....... . ... 1.2 Video Camera .. . .... . .... . .. .. .. ... ..... . ........... . .... ...... ........ ... 1.3 Video Monitors ..................................................... ........ 1.3 Three Dimensional and High Definition Television .. .. ......... .... ................. 1.3 Equipment . ............................. . .......... .. ... ................ . 1.3 Instruments ....................................... ... .... . ............ .... 1.6 Training and Credentialling . ........ . . .. ............. . ... . ............. .. . .... 1.8 2. Lapa .... oscopic AV\ti .... eBi.I\x P .... ocedi.l\ .... es Hartmutb B. Btttner Theodore N. Pappas Anatomy ........... . .............................................. . ...... 2.2 Pathophysiology, Presentation, and Differential Diagnosis ........ .. ........ .. ........ . 2.5 Surgical Technique .............. . ................. . .............. . .... . ... 2.10 Results .. ... .................. . ........... .. ......... .... .... ... .... .. .. 2.15 3. Lapa .... oscopic Vagotomy Cbrlsttne A. Cbeng Theodore N. Pappas Anatomy . . ............ . .. .. ....... . ...... . ............................... 3.3 Pathophysiology, Presentation, and Differential Diagnosis .................... . ........ 3.4 Surgical Technique ..................................... .. . ................. 3.6 Results .............. . ................ ..... ........ . .................... 3.14 4. Lapa .... oscopic aast. ... ostomy aV\d 3eji.l\V\ostomy Ca", H. Meyers Jobn P. Grant Anatomy .. ........ . ........ . ................... . ....... ... .... .. ......... 4.3 Surgical Technique ......... .. . .... ............ .. ..... .... .... .... .... ... ... 4.4 Results . . .... ............... . ........................................... 4.13 5. Lapa .... oscopic aast. ... ojeji.l\V\ostomy Bradley H. ColUns Theodore N. Pappas Anatomy ..................... .. ......... . .................... . .......... . 5.3 Pathophysiology, Presentation, and Differential Diagnosis .............. . .............. 5.4 Surgical Technique ............ ...... ....................................... 5.8 Postoperative Management ................... .. .................. ... ..... . .. . 5.13 Results ................................................................. 5.13 Conclusions .............................................................. 5.13 ix 6. Basic Tech~iques of Lapal"oscopic CholecystectoW\y Cbrlstopber R. Watters Anatomy ................................................................ 6.2 Pathophysiology, Presentation, and Differential Diagnosis ............................ 6.2 Surgical Technique ........................................................ 6.3 Results ................................................................. 6.7 7. Lapal"oscopic Chola~9io91"aphy Bryan M. Clary Tbeodore N. Pappas Anatomy ................................................................ 7.3 Pathophysiology, Presentation, and Differential Diagnosis ............................ 7.5 Diagnosis and Indications far Intraoperative Cholangiography ........................ 7.5 Surgical Technique ........................................................ 7.7 Alternative Technique ..................................................... 7.11 Results ................................................................ 7.15 8. Lapal"oscopic Ma~ageW\e~t of Choledocholithiasis Lewis B. Scbwartz Tbeodore N. Pappas Anatomy and Pathophysiology ............................................... 8.2 Clinical Presentation ....................................................... 8.3 Management of Choledocholithiasis ............................................ 8.3 Surgical Technique ........................................................ 8.4 Results ................................................................. 8.7 9. CoW\plicatio~s of Lapal"oscopic CholecystectoW\y Gene D. Branum Tbeodore N. Pappas Anatomy ................................................................ 9.2 Biliary Complications ...................................................... 9.2 Diagnosis ............................................................... 9.6 Treatment ............................................................... 9.7 Prevention of Injuries ...................................................... 9.8 Miscellaneous Complications ................................................. 9.9 Results ................................................................ 9.11 10. Lapal"oscopic Cholecystojeju~ostoW\y s. Ravi Cbarl Tbeodore N. Pappas Anatomy ............................................................... 10.2 Pathophysiology, Presentation, and Differential Diagnosis ........................... 10.3 Surgical Technique ....................................................... 10.4 Alternative Technique ..................................................... 10.8 11. Lapal"oscopic Livel" Biopsy Ravi S. Cbarl WilUam C Meyers Anatomy ............................................................... 11.2 Pathophysiology, Presentation, and Differential Diagnosis ........................... 11.4 Surgical Technique ....................................................... 11.6 Complications ........................................................... 11.8 x
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