Minimally Invasive Abdominal Surgery: Laparascopic and Thoracic Surgery

479 Pages·2001·41.851 MB·English, German

by  Karl Kremer, Werner Platzer, Hans Wilhelm Schreiber, F. M. Steichen

I
Minimally Invasive Abdominal Surgery
II
III
Minimally Invasive
Abdominal Surgery
Edited by
Karl Kremer, M.D. Werner Platzer, M.D.
Professor Emeritus of Surgery Professor Emeritus of Anatomy
Director, Surgical University Clinic Director, Institute of Anatomy
Düsseldorf, Germany University of Innsbruck
Innsbruck, Austria
Hans Wilhelm Schreiber, M.D. Felicien M. Steichen, M.D.
Professor Emeritus of Surgery Professor of Surgery
Director of General Surgery St. Agnes Hospital
Surgical University Clinic Institute for Minimally
Hamburg, Germany Invasive Surgery
White Plains, N.Y., USA
1088 illustrations by F.v. Aspern, P. Haller, R. Henkel, and R. Lazarus
Thieme
Stuttgart · New York 2001
IV
LibraryofCongressCataloging-in-PublicationData Important Note: Medicine is an ever-changing science under-
isavailablefromthepublisher goingcontinualdevelopment.Researchandclinicalexperience
are continually expanding our knowledge, in particular our
knowledgeofpropertreatmentanddrugtherapy.Insofarasthis
bookmentionsanydosageorapplication,readersmayrestas-
suredthattheauthors,editors,andpublishershavemadeevery
efforttoensurethatsuchreferencesareinaccordancewiththe
stateofknowledgeatthetimeofproductionofthebook.
Nevertheless, this does not involve, imply, or express any
guaranteeorresponsibilityonthepartofthepublishersinre-
spectofanydosageinstructionsandformsofapplicationstated
in the book. Every user is requested to examine carefully the
manufacturer’sleafletsaccompanyingeachdrugandtocheck,if
necessary in consultation with a physician or specialist,
whether the dosage schedules mentioned therein or the con-
traindicationsstatedbythemanufacturersdifferfromthestate-
mentsmadeinthepresentbook.Suchexaminationisparticu-
larly important with drugs that are either rarely used or have
beennewlyreleasedonthemarket.Everydosagescheduleor
every form of application used is entirely at the user’s own
risk and responsibility. The authors and publishers request
everyusertoreporttothepublishersanydiscrepanciesorinac-
curacies noticed.
ThebulkofthisbookisanauthorizedtranslationoftheGerman
edition Minimal-invasive Chirurgie, Vol.7/2 of Chirurgische
Operationslehre, edited by K.Kremer, W.Lierse, W.Platzer,
H.W.Schreiber, S.Weller, published and copyrighted 1995 by
GeorgThiemeVerlag,Stuttgart,Germany.
TranslatedbyJohnGrossman,Berlin
CoverdrawingbyReinholdHenkel,Heidelberg
Anyreferencetoormentionofmanufacturersorspecificbrand ©2001GeorgThiemeVerlag,
namesshouldnotbeinterpretedasanendorsementoradver- Rüdigerstraße 14,
tisementforanycompanyorproduct. D-70469Stuttgart,Germany
Someoftheproductnames,patents,andregistereddesignsre- ThiemeNewYork,333SeventhAvenue,
ferredtointhisbookareinfactregisteredtrademarksorpro- NewYork,NY10001,USA
prietarynames,eventhoughspecificreferencetothisfactisnot
always made in the text. Therefore, the appearance of a name TypesettingbyprimustypeR.HurlerGmbH,
without designation as proprietary is not to be construed as a D-73274 Notzingen
representationbythepublisherthatitisinthepublicdomain. PrintedinItalybyG.Canale&C.,Turin
This book, including all parts thereof, is legally protected by
copyright. Any use, exploitation, or commercialization outside
thenarrowlimitssetbycopyrightlegislation,withoutthepub-
lisher’sconsent,isillegalandliabletoprosecution.Thisapplies
inparticulartophotostatreproduction,copying,mimeograph-
ingorduplicationofanykind,translating,preparationofmicro- ISBN3-13-108191-0(GTV)
films,andelectronicdataprocessingandstorage. ISBN0-86577-639-3(TNY) 1 2 3 4 5
V
Preface
“Primum Non Nocere − First and Foremost Do No Harm”, has Mouret,hasbeenlargelyremediedbythisminimalinvasionof
beenabasicguideforourdiagnosticandtherapeuticendeavors endocavitary, endoluminal, endovascular, and endoarticular
ever since Hippocrates (460−361 B.C.) expressed this principle spaces!
asamajoraphorisminthecareofthesickandinjured.Takento Whiletheinjuryofsurgicalaccesshasbeengreatlyreduced,if
itsrationalconclusioninmodernhealthcare,thismeansthata noteliminated,theindications,strategy,technique,andgoalsof
seemingly injurious and “radical” operative action, when indi- anygiveninternaloperativeprocedurefeasiblethroughamini-
cated,causeslessharmthanmedication-based,“conservative” malapproachhavenotchangedintheiressentialfeatures.This
inaction. For example, the truly “conservative” treatment of AtlasofMinimallyInvasiveSurgerydoesprovideacomprehen-
ruptured appendicitis, a decisive incision, excision of the of- sive and didactic guide to this new art and craft of operative
fendingorgan,and“laudable”drainageofpusissuperiortothe surgerywithintheabdomen.
“radical” use of pills, potions, and various warm or cold com- We wish to thank our contributing authors for their enthusi-
presses.However,thisapproachdoesentailaviolationofana- asm,expertise,andpromptresponses.Mr.GertKruegerandDr.
tomicalintegritywithalltherealandpotential,shortandlong- CliffordBergmanofGeorgThiemeVerlaghaveearnedourgrati-
termmorbidityassociatedwithasurgicalwound,oftenregard- tude for their masterful design and layouts, as well as their
lessoftheurgentorelectivenatureoftheprocedure,especially patiencewithlast-minutechanges.Lastbutnotleast,theartists
ifitisestablishedtocureinfectionorneoplasia. FranziskavonAspern,PeterHaller,ReinholdHenkel,andRobin
Advancesinthetechnologyofendoscopy,theabilitytotransmit Lazarus,deservespecialrecognitionforthewaytheywereable
andprojectanatomicalandpathologicalfindingsontoatelevi- to transform their own operating-room sketches and those of
sion monitor and the progressive mastery of operative skills neophytemedicalillustratorsintotrueworksofsurgicalart.
within a closed space, guided by a two- or three-dimensional
image,havegreatlyreducedandinsomeinstanceseliminated
the handicap of a conventional incision. Local and systemic White Plains, N.Y. Felicien M. Steichen
woundmorbidity,soaptlycalled“maladiedel’incision”byPh. October 2000
VI
Contributors
G.Abtahi H.-P.Bruch,M.D. RobertJ.FitzgibbonsJr.,M.D.,F.A.C.S.,
Chir.Klinik Professor ProfessorofSurgery
Otto-von-GuerickeUniversität DirectorSurg.Clinic Omaha,Nebraska
Leipzig,Germany MedizinischeUniversitätzuLübeck USA
Lübeck,Germany
M.E.,Arregui,M.D.,F.A.C.S. M.E.FranklinJr.,M.D.,F.A.C.S.,
AttendingSurgeon MichaelButters,M.D. ClinicalProfessorofSurgery
St.Vincent’sHospital Professor BaptistMedicalCenter
Indianapolis,IN DirectorClinicforGeneralandVisceral SanAntonio,TX
USA Surgery USA
KrankenhausBietigheim-Bissingen
Bietigheim-Bissingen,Germany K.H.Fuchs,M.D.
G.Berci,M.D.FACS,FRCSEd.
Professor
DirectorEndoscopicResearch
L.R.M.DelGuercio,M.D. Chir.Univ.Klinik
CedarsSinaiMedicalCenter
ProfessorandChairman Würzburg,Germany
Dept.ofSurgery
Dept.ofSurgery
LosAngeles,LA
NewYorkMedicalCollege L.A.Galibert,M.D.
USA
Valhalla,NY AssistantDirector
USA St.AgnesHospital
M.Berry,M.D.
Inst.forMin.Inv.Surgery
AttendingSurgeon
T.R.DeMeester,M.D. WhitePlains,N.Y.
MiguelClaro
ProfessorandChairman USA
Santiago,Chile
Dept.ofSurgery
UniversityofSouthernCalifornia IngoGastinger,M.D.
K.M.Bhuta,M.D. MedicalCenter Professor
AssistantProfessorofSurgery LosAngeles,C.A. Schwarza,Germany
NewYorkMedicalCollege USA
Dept.ofSurgery M.F.Gioscia,M.D.
Valhalla,NY F.Dubois,M.D. AttendingSurgeon
USA President St.AgnesHospital
AcadémieNationaledeChirurgie Inst.forMin.Inv.Surgery
M.Birth,M.D. “LesCordeliers” WhitePlains,NY
KlinikfürChirurgie/ Paris,France USA
Chir.Intensivstation
Universitätsklinikum D.B.Earle,M.D. F.Götz,M.D.
Lübeck,Germany Director,DivisionofMin.Inv.Surgery Professor
BaystateMedicalCenter Linnich,Germany
Springfield,MA
R.Bittner,M.D.
USA E.J.Hagopian
Professor
Dept.ofHepato-BiliarySurgery
DirectorSurg.Clinic
R.Eichen,M.D. HôpitalPaulBrousse
Marienhospital
DirectorSurg.Dept. Paris,France
Stuttgart,Germany
Marienkrankenhaus
Düren,Germany B.L.Herz,M.D.
C.Bloechle,M.D.
DirectorofSurgery
Professor
A.Emmermann,M.D. SoundShoreMedicalCenterof
GeneralSurgery
IsraelitischesKrankenhaus Westchester
Chir.Univ.KlinikHamburg
ChirurgischeKlinik Dept.ofSurgery
Hamburg,Germany
Hamburg,Germany NewRochelle,NY
USA
E.Bodner,M.D. A.Encke,M.D.
Professor Professor M.A.Hopkins,M.D.
ChairmanIISurg.Univ.Clinic DirectorChir.Univ.Klinik AssistantProfessorofSurgery
Innsbruck,Austria Frankfurt,Germany NYUMedicalSchool
NewYork,NY
F.J.Borao,M.D. H.Feussner,M.D. USA
Inst.forMinimallyInvasiveSurgery Surg.ClinicandPolyclinic
St.AgnesHospital Techn.Univ. T.P.Hüttl,M.D.
WhitePlains,NY KlinikumrechtsderIsar Chir.Univ.Klinik
USA Munich,Germany Munich,Germany
VII
Contributors
J.C.Iraci,M.D. BernhardJ.Leibl,M.D. H.P.Rajdeo,M.D.
AttendingSurgeon SupervisingPhysician AssistantProfessorofSurgery
LenoxHillHospital Surg.Clinic NewYorkMedicalCollege
NewYork,NY Marienhospital Valhalla,NY
USA Stuttgart,Germany USA
JakobR.Izbicki,M.D. E.Löhde,M.D. M.Rangraj,M.D.
Professor MedicalDirectorMeoclinic Chief,DivisionofLaparoscopicSurgery
GeneralSurgery MinimallyInvasiveSurgery SoundShore
Chir.Universitätsklinik Berlin,Germany MedicalCenterofWestchester
Hamburg,Germany NewRochelle,NY
USA
J.M.Loubeau,M.D.
J.Jacimowicz,M.D.,Ph.D.FRCS(Ed) AssociateDirectorofSurgery
RaulJ.Rosenthal,M.D.
DepartmentofSurgery LenoxHillHospital
BethIsraelMedicalCenterNewYork
CatharinaHospital NewYork,NY
NewYork,NY
Eindhoven,Netherlands USA
USA
BruceV.MacFayden,Jr.,M.D.
W.Jonat,M.D. A.E.Roth,M.D.
Dept.ofSurgery
ProfessorandDirector Coordinator,SurgicalIntensiveCare
MedicalSchool
Universitäts-FrauenklinikKiel St.AgnesHospital
Houston,TX
Kiel,Germany WhitePlains,NY
USA
USA
L.U.Jung,M.D.
L.Maffucci,M.D.
StatenIslandMedicalGroup K.Rückert,M.D.
AttendingSurgeon
StatenIsland,NY Professor
SoundShore
USA DirectorSurg.ClinicNordHeidberg
MedicalCenterofWestchester
Hamburg,Germany
NewRochelle,NY
R.G.Karanfilian,M.D.
USA
Th.Schiedeck,M.D.
AttendingSurgeon
Chir.Univ.Klinik
SoundShore
V.A.Marrero,M.D. Lübeck,Germany
MedicalCenterofWestchester
DirectorEmeritus
NewRochelle,NY
DepartmentofSurgery Fr.W.Schildberg,M.D.
USA
St.AgnesHospital Professor
WhitePlains,NY DirectorChir.Univ.Klinik
NamirKatkhouda,M.D. USA KlinikumGroßhadern
AssociateProfessorofSurgery
Munich,Germany
Div.ofMin.Inv.Surgery
C.Mann,M.D.
SchoolofMedicine
CarolinaPhysicians E.Schippers,M.D
UniversityofSouthernCalifornia
Greenville,NC Professor
USCHealthcareConsultationCenter
USA JuliusSpitalSurg.Clinic
LosAngeles,CA
GeneralandVisceralSurgery
USA
S.AlejandroMetzger,M.D. Würzburg,Germany
Surg.Clinic
D.Kettler,M.D. Bürgerspital C.A.Schneider,M.D.
Professor Solothurn,Switzerland MillburnSurgicalAssociates
DirectorCenterforAnesthesiology Millburn,NJ
KlinikumderUniversitätGöttingen USA
G.Meyer,M.D.
Göttingen,Germany
Chir.Univ.Klinic
K.Schönleben,M.D.
Munich,Germany
Ch.Klaiber,M.D. Professor
DirectorSurg. DirectorSurg.Clinic
VittorioPaolucci,M.D.
SpitalAarberg KlinikumderStadtLudwigshafen
Professor
Aarberg,Switzerland Ludwigshafen,Germany
OspedaleRegionalediBolzano
DivisionediChirurgiaII
V.Schumpelick,M.D.
F.Köckerling,M.D. Bolzano,Italy
Professor
Professor
Surg.ClinicandPolyclinic
DirectorSurg.Clinic J.H.Peters,M.D.
Univ.KlinikumRheinisch-Westf.Techn.
KrankenhausSiloah AssociateProfessorofSurgery
HochschuleAachen
Hannover,Germany Dept.ofSurgery,SchoolofMedicine,
Aachen,Germany
Univ.ofSouthernCalifornia
ErnstKraas,M.D. LosAngeles,CA N.Soehendra,M.D.
Professor USA Professor
DirectorSurg.Clinic DirectorClinicforInterdisciplinary
KrankenhausMohabit A.Pier,M.D. Endoscopy
Berlin,Germany Aachen,Germany Hamburg,Germany
U.Kunath,M.D. S.D.Potter,M.D. E.B.Sottile,M.D.
Professor AttendingSurgeon ChiefofGeneralSurgery
Surgery,VisceralSurgery ChiltonMemorialHospital St.AgnesHospital
Meoclinic PomptonPlains,NJ WhitePlains,NY
Berlin,Germany USA USA
VIII
Contributors
T.Strate,M.D. GregVanStiegmann,M.D. S.D.Wexner,M.D.,F.A.C.S.,FA.S.C.R.S.
GeneralSurgery Prof.ofSurgery DirectorDept.ofColorectalSurgery
Chir.Univ.Klinik HeadGastrointestinal,Tumor, ClevelandClinicFlorida
Hamburg,Germany andEndocrineSurgery FortLauderdale
UniversityofColorado,SchoolofMedicine USA
G.Stringel,M.D. Denver,CO
Prof.ofSurgeryandPediatrics USA H.K.Yang,M.D.
NewYorkMedicalCollege AttendingSurgeon
Valhalla,NY H.Troidl,M.D. SoundShore
USA Professor MedicalCenterofWestchester
DirectorSurg.ClinicKöln-Merheim NewRochelle,NY
J.Teixeira,M.D. Cologne,Germany USA
AssistantProfessorofSurgery
NewYorkMedicalCollege H.F.Weiser,M.D. C.Zornig,M.D.
Valhalla,NY Professor Professor
USA Diakoniekrankenhaus DirectorSurg.Clinic
Rotenburg,Germany IsraelitischesKrankenhaus
T.A.Thomas,M.D.B24 Hamburg,Germany
St.AgnesHospital R.Welter,M.D.
Inst.Min.Inv.Surgery President
WhitePlains,NY AECV,Telemediana
USA Luxembourg
IX
Contents
1. Introduction
1.1 Introduction ..................................... 1 1.2 MinimallyInvasiveSurgeryandVideolaparoscopic
H.W.Schreiber,F.M.Steichen,E.Kraas Surgery .......................................... 2
H.W.Schreiber,F.M.Steichen,E.Kraas
SurgicalStrategy ................................. 2
2. Instruments and Methods
2.1 Three-DimensionalOpticsinClinicalPractice ...... 6 2.3 JoiningandSealingTissuesandHollowOrgans..... 24
H.P.Bruch,T.H.K.Schiedeck D.B.Earle,L.A.Galibert,M.A..Hopkins,F.M.Steichen
ClinicalApplication ............................... 6 2.4 GaslessLaparoscopy .............................. 51
AdvantagesandDisadvantagesof3-DOpticalSys- V.Paolucci,A.Encke
tem.............................................. 6 2.5 AnesthesiainVideolaparoscopicSurgery........... 54
2.2 AccessandExposureTechniquesinLaparoscopic D.Kettler
Surgery .......................................... 9
L.Galibert,D.B.Earle,F.M.Steichen,G.Stringel
Summary ........................................ 9
3. Laparoscopic Exploration, Diagnosis, and Staging
3.1 VisualExplorationofthePeritonealCavity ......... 59 3.6 DiagnosticLaparoscopyforTumors ................ 75
F.Götz,A.Pier H.Feussner
3.2 DiagnosticLaparoscopyforTrauma................ 61 3.7 StagingofNeoplasticDiseasewithUltrasound ..... 76
H.Feussner M.Birth,H.−F.Weiser
3.3 LaparoscopyfortheAcuteAbdomen............... 68 3.8 CommentsonLaparoscopicUltrasonographyfor
A.Metzger,K.Schönleben,Ch.Klaiber Staging .......................................... 81
3.4 LaparoscopyforPeritonitis ........................ 71 G.VanStiegmann
E.Löhde,E.Kraas 3.9 VisualExplorationofthePelvicOrgansinWomen . 82
3.5 CommentsonLaparoscopyfortheAcuteAbdomen. 74 W.Jonat
M.−E.Arregui
4. Laparoscopic Cholecystectomy
4.1 RetrogradeCholecystectomy ...................... 85 4.3 AlternateMethodofGallbladderRetrieval ......... 119
F.Götz,A.Pier F.Köckerling
4.2 AnterogradeCholecystectomy ..................... 117 4.4 CommentsonLaparoscopicCholecystectomy ...... 126
F.Köckerling G.Berci
5. Extrahepatic Bile Ducts: Diagnosis and Treatment
5.1 UltrasonographyoftheBileDucts ................. 128 5.4 IntraluminalEndoscopicCommonBileDuctEx-
M.Birth,H.−F.Weiser plorationandStoneRetrieval ..................... 137
UltrasoundTechnique ............................ 129 N.Soehendra
5.2 IntraoperativeCholangiography ................... 133 5.5 CommonBileDuctExplorationandStoneRemoval . 142
A.Pier,F.Götz F.Götz,A.Pier
5.3 CommentsonIntraopertiveCholangiography ...... 136 5.6 LaparoscopicCholecystojejunostomy .............. 148
B.V.MacFadyen,Jr. L.U.Jung,M.S.Rangraj,C.A.Schneider,V.Maffucci
5.7 CommentsonLaparoscopicBiliaryOperations