The Role of Laparoscopy in Emergency Abdominal Surgery

226 Pages·2012·6.35 MB·English

by  Ferdinando Agresta

Updates in Surgery
Vincenzo Mandalà (Ed.)
The Role of Laparoscopy
in Emergency Abdominal
Surgery
In collaboration with
Antonino Mirabella
Massimo Lupo
Foreword by
Gianluigi Melotti
11233
EEditor
Vincenzo Mandalà
Surgical and Emergencies Department
“Villa Sofia – Cervello”Hospital Trust
Palermo,Italy
IIn collaboration with
Antonino Mirabella
Massimo Lupo
The publication and the distribution of this volume have been supported by the Italian
Society of Surgery
The Editor acknowledges the educational contribution offered by Johnson & Johnson
MMedical S.p.A.
ISBN 978-88-470-2326-0 e-ISBN 978-88-470-2327-7
DOI 10.1007/978-88-470-2327-7
Springer Milan Dordrecht Heidelberg London New York
Library of Congress Control Number:2011934377
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This book is dedicated to all Italian Surgeons,
a group to which I proudly belong.
To Elisabetta, Giuliana and Stefano,
and the whole family,
in particular to my father,
my greatest supporter during the beginning of my career.

Foreword
It is my great honor and pleasure to write a preface for this new book from
Springer focusing on the role of laparoscopy in emergency surgery.
The work has been edited and supervised by Vincenzo Mandalà, an undis-
puted expert in modern emergency and trauma surgery, and it presents an
excellent overview of the methodologies practiced by the major Italian surgery
schools,which have elevated the mini-invasive approach to a principle govern-
ing their work and, one might add, their overall approach as clinicians.
The book provides an effective summary of many of the already well-estab-
lished techniques as well as other, more innovative ones, all of which are
employed in compliance with the emergency and safety criteria required by
this particular surgical field.
Emergency surgery is one of the most demanding branches of general sur-
gery: time is crucial and any decision must be immediate but nonetheless
agreed upon by a multidisciplinary team of surgeons and anesthesiologists
able to recognize the benefits of mini-invasive surgery not just during the pro-
cedure itself but, above all, during the postoperative period. This is particular-
ly true for the most complex cases. Furthermore, surgeons working in an
increasingly technological setting need to be supported by nursing and med-
ical teams familiar with the sophisticated and constantly changing equipmentt
and materials.
In this setting,continuing education plays a crucial role,and books like this
one, which summarize techniques, protocols, and evidence, can support sur-
geons in their decision-making when they are dealing with the various clinical
and organizational problems common to both small and large hospitals.
The work–one could even say, the mission–that Vincenzo Mandalà has
been carrying out in the most important Italian and international scientific
societies makes him an ideal advocate of the approaches underlying this spe-
cific surgical field and so well-presented in this volume.
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viii Foreword
What is certain is that emergency laparoscopy has made the transition and
is no longer the last diagnostic step but the first–and, in many cases, the
only–therapeutic step.
Thank you Vincenzo for this very fine job!
Rome, October 2011 Gianluigi Melotti
President, Italian Society of Surgery
Preface
Over the last ten years of my professional activity and particularly since 1999 I
have been working as head of department at “Villa Sofia-CTO Hospital Trust”
in Palermo. The mission of the Hospital Trust is emergency (it has been recog-
nized as a level III leading regional center and a DEA level II, a Department off
Emergency and Admission of a high level) and since there was no mini-invasive
surgery unit,I decided to make every effort in my daily professional and organi-
zational life towards this new surgical approach. I wanted not only to improve
elective laparoscopic advanced surgery, but also to raise the level of emergency
surgery by introducing standardized emergency surgery protocols.
Since 1992 I have devoted my professional life to laparoscopic surgery.
During a previous experience as the Director of an operative surgery unit in a
suburban Hospital (Cefalù Hospital), we had to enhance the use of diagnostic
laparoscopy extensively, because of the structural problems and the lack off
radiologic imaging modalities such as CT and MR. The laparoscopic approach
was, therefore, used for abdominal emergencies, particularly appendicularr
peritonitis caused by acute appendicitis and perforated ulcers, acute cholecys-
titis and emergencies of the abdominal wall.
In that period I realized how important diagnostic laparoscopy was not only
for neoplastic problems but also for intra-abdominal peritonitis and for non-
specific abdominal pains that mostly affected young women. I found myselff
being a pioneer of laparoscopic surgery, a technique which can sometimes
ensure therapeutic resolutions with all the benefits that we know.
In 1999,I found in the Villa Sofia hospital the structural strength of a large
hospital equipped with spiral CT scanning, MR, angiography (although limit-
ed), the possibility of intraoperative blood recuperation and intensive care
units. For this reason my main aim was to increase emergency laparoscopic
surgery, although I have to admit I encountered strong resistance from seniorr
doctors and inexperience but enthusiasm in younger colleagues.
Peritonitis and other nontraumatic emergencies using a laparoscopic
approach were the first to be carried out, but as my older colleagues opposed
the use of mini-invasive surgery, especially for hemoperitoneum, I had to ded-
icate myself to tackling abdominal traumas.
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