Copyright â Springer - 2015
1: Development of Minimally Invasive Colorectal Surgery: History, Evidence, Learning Curve, and Current Adaptation
2: Preoperative Planning and Postoperative Care in Minimal Invasive Colorectal Surgery
Contraindications for Laparoscopic or Robotic Surgery
Specific Operative Issues
Postoperative Nausea and Vomiting
Postoperative Complications
Venous Thromboembolism Prophylaxis
3: Operating Room Setup and General Techniques in Minimal Invasive Colorectal Surgery
Laparoscopes, Cameras, Light Source, and Monitor
General OR Setup for Minimal Invasive Colorectal Surgery
Laparoscopic Right Hemicolectomy
Laparoscopic Total Abdominal Colectomy, Left Hemicolectomy, Sigmoidectomy, Low Anterior Resection, and Abdominoperineal Resection
Robotic Right Hemicolectomy
Robotic Low Anterior Resection, Proctectomy
Obtaining Intraperitoneal Access
Single Port and Hand Assist
Techniques for Port Closure
4: Operating Room Setup and General Techniques for Robotic Surgery
Preparation for Robotic Surgery
General OR Setup for Robotic Surgery
Navigating the Camera and the Surgical Instruments
Needle Holding, Suturing, and Knot Tying
Control of Electrocoagulation/Energy
Advanced Tools for Colorectal Surgery
Firefly Fluorescence Imaging
Robotic Bipolar Vessel Sealer
Avoiding Equipment Malfunction
Robotic Preoperative Checklist
Part II: Right Hemicolectomy and Ileocecectomy
5: Right Hemicolectomy and Ileocecectomy: Laparoscopic Approach
Port Placement and Extraction Sites
Room Setup and Positioning
Operative Steps (Table 5.1)
Identification and Ligation of the Ileocolic Vessels
Dissection of the Retroperitoneal Plane and Identification of the Duodenum
Mobilization of the Right Colon and Terminal Ileum
Mobilization of the Proximal Transverse Colon and Hepatic Flexure
Extracorporeal Anastomosis, Closure, and Reinspection
Identification and Ligation of the Middle Colic Vessels
Lateral to Medial Approach
Medial to Lateral Approach
Inferior to Superior Approach
Intracorporeal Anastomosis
Hand-Assisted Laparoscopic Right Hemicolectomy
Special Considerations and Complications
Enterotomy and Duodenal Injury
Difficulty with Identification of Tumor or Lesion
6: Right Hemicolectomy and Ileocecectomy: Hand-Assisted Laparoscopic Approach
Room Setup and Positioning
Port Placement and Extraction Sites
Operative Steps (Table 6.1)
Exploratory Laparoscopy and Insertion of Hand Port
Identification and Ligation of the Ileocolic Vessels
Dissection of the Retroperitoneal Plane and Duodenum
Mobilization of the Right Colon and Terminal Ileum
Identification and Ligation of the Middle Colic Vessels
Mobilization of Proximal Transverse Colon and Hepatic Flexure
Extracorporeal Anastomosis, Closure, and Reinspection
Lateral to Medial Approach
Inferior to Superior Approach
Medial to Lateral Approach
Superior to Inferior Approach
Special Considerations and Complications
7: Right Hemicolectomy and Ileocecectomy: Single-Port Laparoscopic Approach
Port Placement and Extraction Sites
Room Setup and Positioning
Operative Steps (Table 7.1)
Identification and Ligation of the Ileocolic Vessels
Insertion of the Single Port and Exploratory Laparoscopy
Dissection of the Retroperitoneal Plane and Identification of the Duodenum
Extracorporeal Anastomosis, Closure, and Reinspection
Identification and Ligation of the Middle Colic Vessels
Mobilization of the Proximal Transverse Colon and Hepatic Flexure
Mobilization of the Right Colon and Terminal Ileum
Medial to Lateral Approach
Rollover Technique or Modified Lateral to Medial and Inferior Approach
Special Considerations and Complications
8: Right Hemicolectomy and Ileocecectomy: Laparoscopic Intracorporeal Anastomosis
Room Setup and Patient Positioning
Operative Steps (Table 8.1)
Identification of Duodenum and Ligation of the Ileocolic Vessels
Mobilization of the Proximal Transverse Colon and Hepatic Flexure
Mobilization of the Right Colon and Terminal Ileum
Intestinal Division and Specimen Bagging
Intracorporeal Anastomosis
Side-to-Side Retroperistaltic Anastomosis
Side-to-Side Isoperistaltic Anastomosis
Anastomotic Leak Testing with Colonoscope
Port Placement and Extraction Sites
9: Right Hemicolectomy and Ileocecectomy: Robotic Approach
Port Placement and Extraction Sites
Room Setup and Positioning
Operative Steps (Table 9.1)
Exploratory Laparoscopy and Docking
Dissection of the Retroperitoneal Plane and Identification of the Duodenum
Identification and Ligation of the Ileocolic Vessels
Mobilization of the Proximal Transverse Colon and Hepatic Flexure
Mobilization of the Right Colon and Terminal Ileum
Extracorporeal or Intracorporeal Anastomosis, Closure and Reinspection
Identification and Ligation of the Middle Colic Vessels
Inferior to Superior Approach
Lateral to Medial Approach
Medial to Lateral Approach
Special Considerations and Complications
Robotic Docking Complications
Enterotomy or Duodenal Injury
10: Right Hemicolectomy and Ileocecectomy: Single-Port Robotic Approach
Operative Steps (Table 10.1)
Single-port Insertion and Exploratory Laparoscopy
Identification and Ligation of the Ileocolic Vessels
Dissection of the Retroperitoneal Plane
Mobilization of the Proximal Transverse Colon and Hepatic Flexure
Extracorporeal Anastomosis
Identification and Ligation of the Middle Colic Vessels
Mobilization of the Right Colon and Terminal Ileum
Port Placement and Extraction Sites
Room Setup and Positioning
11: Right Hemicolectomy and Ileocecectomy: Robotic Intracorporeal Anastomosis
Operative Steps (Table 11.1)
Division of the Ileal Mesentery and Transverse Mesocolon
Intracorporeal Anastomosis
Antiperistaltic V Anastomosis
Commonalities of Constructing Intracorporeal Anastomoses
Isoperistaltic I Anastomosis
Common Steps Immediately Subsequent to Anastomotic Construction
Isoperistaltic M Anastomosis
Port Placement and Extraction Sites
Room Setup and Patient Positioning
12: Transverse Colectomy: Laparoscopic Approach
Port Placement and Extraction Sites
Room Setup and Patient Positioning
Operative Steps (Table 12.1)
Omental Division or Resection
Hepatic Flexure Mobilization
Identification and Ligation of the Middle Colic Vessels
Splenic Flexure Mobilization
Extracorporeal Anastomosis, Closure, and Re-inspection
Part III: Sigmoid and Left Hemicolectomy, Hartmanns Reversal
13: Sigmoid Colectomy and Left Hemicolectomy: Laparoscopic Approach
Port Placement and Extraction Sites
Room Setup and Positioning
Operative Steps (Table 13.1)
Identification of the Ureter and Ligation of the Inferior Mesenteric Artery
Mobilization of the Descending Colon and Splenic Flexure with Identification and Ligation of the Inferior Mesenteric Vein
Mobilization of the Sigmoid Colon
Anastomosis with Leak Test
Transection of the Sigmoid Colon
Laparoscopic Left Hemicolectomy
Laparoscopic Reversal of a Hartmann’s Resection
Lateral to Medial Approach
Medial to Lateral Approach
Superior to Inferior Approach
Special Considerations and Complications
Inability to Identify Tumor
Inadequate Length of Colon for Tension-Free Anastomosis
14: Sigmoid Colectomy and Left Hemicolectomy: Hand-Assisted Laparoscopic Approach
Room Setup and Positioning
Port Placement and Extraction Sites
Operative Steps (Table 14.1)
Exploratory Laparoscopy and Insertion of the Hand Port
Identification and Division of Inferior Mesenteric Artery
Mobilization of the Sigmoid Colon
Mobilization of the Splenic Flexure
Anastomosis with Leak Test
Transection of the Sigmoid Colon
Hand-assisted Laparoscopic Left Hemicolectomy
Hand-Assisted Laparoscopic Reversal of a Hartmann’s Resection
Lateral to Medial Approach
Medial to Lateral Approach
Superior to Inferior Approach
Special Considerations and Complications
Inability to Identify Tumor
Inadequate Length of Colon for Tension-Free Anastomosis
15: Sigmoid Colectomy and Left Hemicolectomy: Single-Port Laparoscopic Approach
Room Setup and Positioning
Port Placement and Extraction Sites
Operative Steps (Table 15.1)
Insertion of the Single Port and Exploratory Laparoscopy
Mobilization of the Sigmoid Colon, Identification of the Left Ureter, and Ligation of the Inferior Mesenteric Artery
Mobilization of the Descending Colon and Splenic Flexure with Identification and Ligation of the Inferior Mesenteric Vein
Anastomosis with Leak Test
Transection of the Sigmoid Colon
Single-Port Laparoscopic Reversal of a Hartmann’s Resection
16: Sigmoid Colectomy and Left Hemicolectomy: Robotic Approach
Room Setup and Positioning
Port Placement and Extraction Sites
Operative Steps (Table 16.1)
Exploratory Laparoscopy and Robotic Docking
Identification and Ligation of the Inferior Mesenteric Artery
Mobilization of the Descending Colon and Splenic Flexure with Identification and Ligation of the Inferior Mesenteric Vein
Anastomosis with Leak Test
Mobilization of the Sigmoid Colon
Transection of the Sigmoid Colon
Robotic Reversal of a Hartmann’s Resection
Part IV: Low Anterior Resection, Abdominoperineal Resection and Rectopexy
17: Proctectomy and Rectopexy: Laparoscopic Approach
Port Placement and Extraction Sites
Room Setup and Positioning
Operative Steps (Table 17.1)
Identification of the Ureter and Ligation of the Inferior Mesenteric Artery
Mobilization of the Descending Colon and Splenic Flexure with Identification and Ligation of the Inferior Mesenteric Vein
Mobilization of the Sigmoid Colon
Anastomosis with Leak Test
Transection of the Rectum
Special Considerations and Complications
Abdominoperineal Resection (APR)
Posterior Rectopexy Technique
Anterior Rectopexy Technique
18: Proctectomy and Rectopexy: Hybrid Robotic Approach
Room Setup and Positioning
Operative Steps (Table 18.1)
Identification of the Ureter and Ligation of the Inferior Mesenteric Vessels
Mobilization of the Descending Colon and Splenic Flexure
Mobilization of the Sigmoid Colon
Transection of the Rectum
Anastomosis with Leak Test
Port Setups and Extraction Sites
Abdominoperineal Resection
19: Proctectomy: Total Robotic Approach
Room Setup and Positioning
Port Setups and Extraction Sites
Operative Steps (Table 19.1)
Identification of the Ureter and Ligation of the Inferior Mesenteric Artery
Mobilization of the Sigmoid Colon
Mobilization of the Descending Colon and Splenic Flexure with Identification and Ligation of the Inferior Mesenteric Vein
Transection of the Rectum
Anastomosis with Leak Test
Double Purse-String Robotic Stapled Anastomosis Technique
Intersphincteric Resection, Distal Mucosectomy, and Hand-Sewn Coloanal Anastomosis
Abdominoperineal Resection
Part V: Total Colectomy with Ileorectal Anastomosis and Proctocolectomy with Ileoanal Pouch
20: Total Colectomy and Proctocolectomy: Laparoscopic Approach
Port Placement and Extraction Sites
Room Setup and Positioning
Operative Steps (Table 20.1)
Mobilization of the Cecum and Ascending Colon and Ligation of the Ileocolic Vessels
Mobilization of the Hepatic Flexure and Transverse Colon and Ligation of the Middle Colic Vessels
Mobilization of the Sigmoid Colon, Descending Colon, and Splenic Flexure and Ligation of the Inferior Mesenteric Artery
Rectal Mobilization and Transection
Transection of the Colon, Anastomosis, and Reinspection
21: Total Colectomy and Proctocolectomy: Hand-Assisted Laparoscopic Approach
Operative Steps (Table 21.1)
Exploratory Laparoscopy and Insertion of the Hand Port
Mobilization of the Cecum, Ascending Colon, and Hepatic Flexure and Ligation of the Ileocolic Vessels
Mobilization of the Transverse Colon and Ligation of the Middle Colic Vessels
Mobilization of the Sigmoid Colon, Descending Colon, and Splenic Flexure and Ligation of the Inferior Mesenteric Artery
Transection of the Colon, Anastomosis, and Reinspection
Laparoscopic Hand-Assisted Proctocolectomy with Ileal Pouch Anal Anastomosis
Operative Steps (Table 21.2)
Transection of the Rectum and Ileal Pouch Anal Anastomosis
Port Placement and Extraction Sites
Room Setup and Positioning
22: Total Colectomy and Proctocolectomy: Single-Port Laparoscopic Approach
Room Setup and Patient Positioning
Operative Steps (Table 22.1)
Single-Port Insertion and Exploratory Laparoscopy
Mobilization of the Cecum, Ascending Colon, and Hepatic Flexure and Ligation of the Ileocolic Vessels
Mobilization of the Hepatic Flexure and Transverse Colon and Ligation of the Middle Colic Vessels
Mobilization of the Sigmoid Colon, Descending Colon, and Splenic Flexure and Ligation of the Inferior Mesenteric Artery
Rectal Mobilization, Transection of the Rectum, and IPAA
Transection of the Colon and Ileorectal Anastomosis
Part VI: Stoma Construction (Loop Ileostomy, Loop and End Colostomy)
23: Stoma Construction: Laparoscopic Approach
Room Setup and Positioning
Operative Steps (Table 23.2)
Identification and Mobilization of Bowel to Be Exteriorized
Reinspection and Port Closure
Gasless Laparoscopic Stoma
Single-Site Laparoscopic Stoma
Trephine Stoma and Endoscopic-Assisted Stoma
24: Stoma Construction: Single-Port Laparoscopic Approach
Room Setup and Positioning
Operative Steps (Table 24.1)
Identification and Mobilization of Bowel
Port Placement and Exploratory Laparoscopy
Exteriorization of the Bowel
Description of Alternative Operative Approach
Special Considerations and Complications
Part VII: Transanal Endoscopic Surgery
25: Transanal Endoscopic Surgery (TES)
Palliation of Rectal Cancer
Rectovaginal and Rectourethral Fistulas
Advanced Applications (Advanced Resection and NOTES)
Patient Selection and Workup
Basic Operative Setup and Instrumentation
Postoperative Care and Complications
26: Transanal Endoscopic Microsurgery (TEM)
Operative Platform Setup and Instrumentation
Room Setup and Positioning
Partial-Thickness Excision
Operative Steps (Table 26.1)
Establishing Access and Pneumorectum
Natural Orifice Specimen Extraction
27: Transanal Minimally Invasive Surgery (TAMIS)
Port Setup and Instrumentation
Room Setup and Positioning
Operative Steps (Table 27.1)
Establishing Access and Pneumorectum
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