Atlas of Single-Incision Laparoscopic Operations in General Surgery

450 Pages·2013·82.75 MB·English

by  Shuodong Wu, Ying Fan, Yu Tian (auth.), Shuodong Wu, Ying Fan, Yu Tian (eds.)

Shuodong Wu
Ying Fan
Yu Tian Editors
Atlas of
Single-Incision
Laparoscopic Operations
in General Surgery
123
Atlas of Single-Incision Laparoscopic Operations
in General Surgery

Shuodong W u (cid:129) Y ing Fan (cid:129) Yu Tian
Editors
Atlas of Single-Incision
Laparoscopic Operations
in General Surgery
Editors
Shuodong Wu
Ying Fan
Yu Tian
Minimal Invasive Surgery and Bile Duct Surgery
Shengjing Hospital
China Medical University
Shenyang
China
ISBN 978-94-007-6954-0 ISBN 978-94-007-6955-7 (eBook)
DOI 10.1007/978-94-007-6955-7
Springer Dordrecht Heidelberg New York London
Library of Congress Control Number: 2013944056
© Springer Science+Business Media Dordrecht 2013
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Preface
With the development and improvement of laparoscopic equipment, conventional laparoscopic
operation techniques have become standardized and are the mainstream of surgical operations
all over the world. Taking 1987 as the year of the introduction of minimally invasive surgery,
in the course of 25 years it has experienced twists and turns. We are the generation of surgeons
witnessing the rapid development of science and technology and I feel great joy and pride and
am honored to participate in this great medical reform, and in persistently pursuing and explor-
ing the possibilities. But I always remind myself not to be complacent or vain, or stop improv-
ing. It is a doctor’s duty to serve patients by relieving pain and facilitating fast recovery. The
concept of natural orifi ce transluminal endoscopic surgery (NOTES) or “no scar surgery” is a
refl ection of this point. We are going forward with continuous improvement and development.
Since 2008, single-incision laparoscopic technique has been well-known all over the world.
“Atlas of single-incision laparoscopic operations in general surgery” is the summary and accu-
mulation of the experience of more than 1,000 cases and 40 categories of operations carried
out by the chief editors and their team. This book provides HD video pictures in the arrange-
ment of operation steps and description in words to facilitate observation and understanding.
Tips and tricks, together with complications and management, are also discussed to help read-
ers to carry out these operations in the clinic.
Like any other science or technology, any type of minimally invasive technique will never
be the best, only better than before. So I hope my limited experience in single-incision laparo-
scopic surgery will help this technique to fl ourish. Guidance and criticism are cordially
welcomed.
In the process of compiling this book, chief editors Ying Fan and Yu Tian spent valuable
time on information collection, selection, and arrangement, and processing the text. Associate
professor Hong Yu and lecturer Yu Xiaopeng and others sacrifi ced a great deal of spare time in
editing the pictures. I express my sincere gratitude and regards to all of them for helping to
publish this book.
Shenyang City, Liaoning Province, China Shuodong Wu
v

Contents
1 Sketch of Single-Incision Laparoscopic Surgery (SILS) . . . . . . . . . . . . . . . . . 1
2 Esophageal Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2.1 Laparoscopic Hiatus Hernioplasty and Nissen Fundoplication. . . . . . . . . . . 4
2.1.1 Indications and Case Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
2.1.2 Contraindications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
2.1.3 Major Instruments or Energy Sources. . . . . . . . . . . . . . . . . . . . . . . . 4
2.1.4 Team Setup, Anesthesia and Position . . . . . . . . . . . . . . . . . . . . . . . . 4
2.1.5 Key Steps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2.1.6 Surgical Techniques. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2.1.7 Tips and Tricks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
2.2 Laparoscopic Heller Myotomy and Dor Fundoplication. . . . . . . . . . . . . . . . 16
2.2.1 Indications and Case Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
2.2.2 Contraindications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
2.2.3 Major Instruments or Energy Sources. . . . . . . . . . . . . . . . . . . . . . . . 16
2.2.4 Team Setup, Anesthesia and Position . . . . . . . . . . . . . . . . . . . . . . . . 16
2.2.5 Key Steps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
2.2.6 Surgical Techniques. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
2.2.7 Tips and Tricks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
2.3 Complications Analysis and Management . . . . . . . . . . . . . . . . . . . . . . . . . . 27
2.3.1 Haemorrhage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
2.3.2 Esophageal Perforation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
2.3.3 Spleen Damage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
2.3.4 Esophageal Leak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
2.3.5 Dysphagia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
2.3.6 Postoperative Stenosis Does Not Alleviate. . . . . . . . . . . . . . . . . . . . 27
2.3.7 Gastric Acid Refl ux. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
2.3.8 Other Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
3 Gastrointestinal Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
3.1 Laparoscopic Partial Gastrectomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
3.1.1 Indications and Case Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
3.1.2 Contraindications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
3.1.3 Major Instruments or Energy Sources. . . . . . . . . . . . . . . . . . . . . . . . 31
3.1.4 Team Setup, Anesthesia and Position . . . . . . . . . . . . . . . . . . . . . . . . 31
3.1.5 Key Steps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
3.1.6 Surgical Techniques. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
3.1.7 Tips and Tricks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
3.2 Laparoscopic Subtotal Gastrectomy(Billroth-IIanastomosis). . . . . . . . . . . . 36
3.2.1 Indications and Case Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
3.2.2 Contraindications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
vii
viii Contents
3.2.3 Major Instruments or Energy Sources. . . . . . . . . . . . . . . . . . . . . . . . 36
3.2.4 Team Setup, Anesthesia and Position . . . . . . . . . . . . . . . . . . . . . . . . 36
3.2.5 Key Steps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
3.2.6 Surgical Techniques. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
3.2.7 Tips and Tricks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
3.3 Laparoscopic Proximal Gastrectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
3.3.1 Indications and Case Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
3.3.2 Contraindications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
3.3.3 Major Instruments or Energy Sources. . . . . . . . . . . . . . . . . . . . . . . . 54
3.3.4 Team Setup, Anesthesia and Position . . . . . . . . . . . . . . . . . . . . . . . . 54
3.3.5 Key Steps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
3.3.6 Surgical Techniques. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
3.3.7 Tips and Tricks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
3.4 Laparoscopic Total Gastrectomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
3.4.1 Indications and Case Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
3.4.2 Contraindications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
3.4.3 Major Instruments or Energy Sources. . . . . . . . . . . . . . . . . . . . . . . . 72
3.4.4 Team Setup, Anesthesia and Position . . . . . . . . . . . . . . . . . . . . . . . . 72
3.4.5 Key Steps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
3.4.6 Surgical Techniques. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
3.4.7 Tips and Tricks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
3.5 Complications Analysis and Management . . . . . . . . . . . . . . . . . . . . . . . . . . 93
3.5.1 Haemorrhage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
3.5.2 Anastomotic Leak and Duodenal Stump Dehiscence. . . . . . . . . . . . 93
3.5.3 Anastomotic Obstruction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
3.5.4 Intraoperative Failing Anastomosis. . . . . . . . . . . . . . . . . . . . . . . . . . 93
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
4 Colorectal Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
4.1 Laparoscopic Cecectomy and Terminal Ileum Resection. . . . . . . . . . . . . . . 97
4.1.1 Indications and Case Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
4.1.2 Contraindications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
4.1.3 Major Instruments or Energy Sources. . . . . . . . . . . . . . . . . . . . . . . . 97
4.1.4 Team Setup, Anesthesia and Position . . . . . . . . . . . . . . . . . . . . . . . . 97
4.1.5 Key Steps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
4.1.6 Surgical Techniques. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
4.1.7 Tips and Tricks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
4.2 Laparoscopic Right Hemicolectomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
4.2.1 Indications and Case Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
4.2.2 Contraindications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
4.2.3 Major Instruments or Energy Sources. . . . . . . . . . . . . . . . . . . . . . . . 106
4.2.4 Team Setup, Anesthesia and Position . . . . . . . . . . . . . . . . . . . . . . . . 106
4.2.5 Key Steps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
4.2.6 Surgical Techniques. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
4.2.7 Tips and Tricks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
4.3 Laparoscopic Transverse Colectomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
4.3.1 Indications and Case Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
4.3.2 Contraindications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
4.3.3 Major Instruments or Energy Sources. . . . . . . . . . . . . . . . . . . . . . . . 118
4.3.4 Team Setup, Anesthesia and Position . . . . . . . . . . . . . . . . . . . . . . . . 118
4.3.5 Key Steps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
4.3.6 Surgical Techniques. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Contents ix
4.4 Laparoscopic Sigmoidectomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
4.4.1 Indications and Case Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
4.4.2 Contraindications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
4.4.3 Major Instruments or Energy Sources. . . . . . . . . . . . . . . . . . . . . . . . 125
4.4.4 Team Setup, Anesthesia and Position . . . . . . . . . . . . . . . . . . . . . . . . 125
4.4.5 Key Steps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
4.4.6 Surgical Techniques. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
4.4.7 Tips and Tricks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
4.5 Laparoscopic Radical Resection of Rectal Carcinoma
(Dixon Technique). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
4.5.1 Indications and Case Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
4.5.2 Contraindications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
4.5.3 Major Instruments or Energy Sources. . . . . . . . . . . . . . . . . . . . . . . . 135
4.5.4 Team Setup, Anesthesia and Position . . . . . . . . . . . . . . . . . . . . . . . . 135
4.5.5 Key Steps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
4.5.6 Surgical Techniques. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
4.5.7 Tips and Tricks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
4.6 Laparoscopic Radical Resection of Rectal Carcinoma
(Miles Technique) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
4.6.1 Indications and Case Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
4.6.2 Contraindications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
4.6.3 Major Instruments or Energy Sources. . . . . . . . . . . . . . . . . . . . . . . . 147
4.6.4 Team Setup, Anesthesia and Position . . . . . . . . . . . . . . . . . . . . . . . . 147
4.6.5 Key Steps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
4.6.6 Surgical Techniques. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
4.6.7 Tips and Tricks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
4.7 Laparoscopic Pancolectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
4.7.1 Indications and Case Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
4.7.2 Contraindications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
4.7.3 Major Instruments or Energy Sources. . . . . . . . . . . . . . . . . . . . . . . . 162
4.7.4 Team Setup, Anesthesia and Position . . . . . . . . . . . . . . . . . . . . . . . . 162
4.7.5 Key Steps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
4.7.6 Surgical Techniques. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
4.8 Laparoscopic Appendectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
4.8.1 Indications and Case Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
4.8.2 Contraindications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
4.8.3 Major Instruments or Energy Sources. . . . . . . . . . . . . . . . . . . . . . . . 175
4.8.4 Team Setup, Anesthesia and Position . . . . . . . . . . . . . . . . . . . . . . . . 175
4.8.5 Key Steps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
4.8.6 Surgical Techniques. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
4.8.7 Tips and Tricks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
4.9 Complications Analysis and Management . . . . . . . . . . . . . . . . . . . . . . . . . . 181
4.9.1 Haemorrhage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
4.9.2 Intestinal Injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
4.9.3 Urinary Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
4.9.4 Complications of Anastomotic Stoma. . . . . . . . . . . . . . . . . . . . . . . . 181
4.9.5 Internal Hernia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
5 Hepatobiliary Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
5.1 Laparoscopic Cholecystectomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
5.1.1 Indications and Case Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
5.1.2 Contraindications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
5.1.3 Major Instruments or Energy Sources. . . . . . . . . . . . . . . . . . . . . . . . 184