Laparoscopic Colon Surgery. Milestones, Education, & Best Practice

Foreword
Preface
Contents
Contributors
Introduction
1: Milestones in Laparoscopic Colon Surgery
	1.1	 Introduction
	1.2	 Definitions
		1.2.1	 Endoscopy
		1.2.2	 Laparoscopy
	1.3	 In the Beginning
		1.3.1	 Ancient Times
		1.3.2	 Pre-modern Times
		1.3.3	 Modern Laparoscopy
	1.4	 Laparoscopic Colectomy
	1.5	 Conclusion
	References
2: Types of Colon Surgery and Anatomy
	2.1	 Introduction
	2.2	 Anatomy of Colon and Rectum
		2.2.1	 Vascular System of the Colon Arterial Supply
			2.2.1.1	 Venous Drainage
			2.2.1.2	 Lymphatic Drainage
	2.3	 Laparoscopic Right Hemicolectomy
		2.3.1	 Trocar Placement
		2.3.2	 Mobilization of the Cecum, Ascending Colon, and Transverse Colon
		2.3.3	 Vascular Approach
		2.3.4	 Specimen Extraction, Anastomosis, and End of Operation
	2.4	 Laparoscopic Left Hemicolectomy and Sigmoidectomy
		2.4.1	 Trocar Placement (Fig. 2.14)
		2.4.2	 Exposure of the Operative Field
		2.4.3	 Vascular Approach
		2.4.4	 Mobilization of the Sigmoid and Descending Colon
		2.4.5	 Mobilization of the Splenic Flexure
		2.4.6	 Dissection of the Upper Mesorectum and Resection of the Specimen
		2.4.7	 Extraction of the Specimen, Anastomosis, and End of Operation
	2.5	 Laparoscopic Subtotal Colectomy
	2.6	 Laparoscopic Hartmann’s Procedure and Hartmann’s Reversal
	2.7	 Laparoscopic Low Anterior Colectomy and Abdominoperineal Resection
	2.8	 Laparoscopic Colectomy in an Obese Patient
	References
3: Preoperative Evaluation and Selection of Patients
	3.1	 Introduction
	3.2	 General Indications and Contraindications for Laparoscopic Surgery
	3.3	 Special Considerations
		3.3.1	 Inflammatory Bowel Disease
			3.3.1.1	 Crohn’s Disease
			3.3.1.2	 Ulcerative Colitis
		3.3.2	 Endometriosis
		3.3.3	 Diverticulitis
		3.3.4	 Benign Tumors
		3.3.5	 Malignant Tumors
	3.4	 Conclusions
	American Society of Anesthesiologists’ Risk Classification (ASA) Status
	References
4: Instruments
	4.1	 Introduction
	4.2	 Patient’s and Surgeon’s Positioning
	4.3	 Types of Instrument for Laparoscopic Colon Surgery
		4.3.1	 Insufflator
		4.3.2	 Laparoscope
		4.3.3	 Light Source
		4.3.4	 Camera
		4.3.5	 Monitor
		4.3.6	 Recording Devices
		4.3.7	 Entry Methods and Instrumentation
			4.3.7.1	 The Veress Needle Technique
			4.3.7.2	 The Hasson Technique
			4.3.7.3	 The Direct Trocar Insertion Technique
				Trocars
			4.3.7.4	 Grasping and Dissecting Instruments
		4.3.8	 Endoscopic Devices for Anastomosis
			4.3.8.1	 AKA-2
			4.3.8.2	 Valtrac BAR
			4.3.8.3	 Compression Anastomotic Clips (CAC)
			4.3.8.4	 Endoluminal Compression Anastomotic Ring
		4.3.9	 Devices for Vessel Ligation
			4.3.9.1	 Titanium Clips
			4.3.9.2	 Polymer Clips
			4.3.9.3	 Energy Sources
				Monopolar Electrosurgery
				Bipolar Electrosurgery
				Ultrasonic Energy
				Radiofrequency Energy
			4.3.9.4	 Instruments for Dividing and Anastomosing the Colon and Rectum (Endostaplers)
		4.3.10	 Wound Protectors
	4.4	 Conclusions
	References
5: Surgical Techniques
	5.1	 Introduction
	5.2	 Right Hemicolectomy
		5.2.1	 Pneumoperitoneum, Laparoscopy, and Port Placement
		5.2.2	 Medial, Ileocolic Vessels
		5.2.3	 Medial, Middle Colic Vessels
		5.2.4	 Medial, Colon Mobilization
		5.2.5	 Lateral, Ileocecal Mobilization
		5.2.6	 Lateral, Right Colon Mobilization
		5.2.7	 Resection and Reconstruction
	5.3	 Extended Right Hemicolectomy
	5.4	 Left Hemicolectomy
		5.4.1	 Pneumoperitoneum, Laparoscopy, Port Placement
		5.4.2	 Medial, Inferior Mesenteric Artery
		5.4.3	 Splenic Flexure Mobilization
		5.4.4	 Distal Division of the Colon
		5.4.5	 Resection and Reconstruction
	5.5	 Sigmoid Colectomy for Diverticular Disease
	5.6	 Low Anterior Resection, Total Mesorectal Excision
		5.6.1	 Pneumoperitoneum, Laparoscopy, Port Placement
		5.6.2	 Medial, Inferior Mesenteric Artery
		5.6.3	 Splenic Flexure Mobilization
		5.6.4	 Total Mesorectal Excision
		5.6.5	 Resection and Reconstruction
	5.7	 Total Proctocolectomy with Ileoanal J-Pouch Anastomosis
		5.7.1	 Pneumoperitoneum, Laparoscopy, Port Placement
		5.7.2	 Right Colon
		5.7.3	 Left Colon
		5.7.4	 Rectal Excision
		5.7.5	 Resection and Reconstruction
6: Complications in Laparoscopic Colorectal Surgery
	6.1	 Introduction
	6.2	 Surgical Complications
	6.3	 Complications Related to the Laparoscopic Technique
		6.3.1	 Complications Related to Initial Abdominal Entry
		6.3.2	 Complications Related to Pneumoperitoneum
	6.4	 Vascular Injuries
		6.4.1	 Minor Vessel Injury
		6.4.2	 Major Vessel Injury
	6.5	 Bowel Injuries
	6.6	 Duodenal Injury
	6.7	 Ureter Injury
	6.8	 Splenic Injury
	6.9	 Failure in Lesion Localization
	6.10	 Conversion to Open Surgery
	6.11	 Anastomotic Leak
	6.12	 Port Site Hernia
	6.13	 Tumor Recurrence
	6.14	 Medical Complications
	6.15	 Conclusions
	References
7: Robotic Colon Surgery and Quality of Life
	7.1	 The Advent of Robotic Colon Surgery
	7.2	 Robotic Colon Surgery Procedures and Techniques
		7.2.1	 Robotic Right Colectomy
		7.2.2	 Robotic Left Colectomy
			7.2.2.1	 The Single-Docking Technique
			7.2.2.2	 The Double-Docking Technique
			7.2.2.3	 The Hybrid Technique
		7.2.3	 Robotic Rectal Surgery
	7.3	 Additional Benefits of the Robotic Surgery in the Quality of Life of Patients
	7.4	 Conclusions
	References
8: Laparoscopic Colon Surgery: Education and Best Practices
	8.1	 Introduction
	8.2	 Training
	8.3	 Training Modalities
		8.3.1	 Video Training
		8.3.2	 Simulators
		8.3.3	 Animal Models and Cadavers
			8.3.3.1	 Animals
			8.3.3.2	 Cadavers
	8.4	 Tutorials
	8.5	 Operating Room Experience: The Role of Hand-Assisted Laparoscopic Colectomy
	8.6	 Conclusion: A Complete Curriculum
	References
9: Anesthesia in Laparoscopic Colorectal Surgery
	9.1	 Introduction
	9.2	 Insufflation of CO2
	9.3	 Pathophysiologic Changes
		9.3.1	 Respiratory System
		9.3.2	 Cardiovascular System
		9.3.3	 Renal Effects
		9.3.4	 Cerebral Effects
		9.3.5	 Splanchnic Effects
	9.4	 Positioning
	9.5	 Immune and Stress Response
	9.6	 Anesthetic Management
	9.7	 Pain Management
	9.8	 Conclusion
	References
Acronyms