Laparoscopic Colorectal Surgery: A Step by Step Guide with Video Atlas

Cover
Half Title
Title Page
Copyright Page
Contents
Video Atlas of Laparoscopic Colorectal
Foreword
Preface
Acknowledgments
Editor
Contributors
Section I: Introduction and Basic Concepts
	1. History, Evolution, and Current Scenario of Laparoscopic Colorectal Surgery
		Learning objectives
		Introduction
		Evolution of laparoscopic surgery
			Technological evolution
			Evolution of laparoscopic surgery in general
		Technical evolution of rectal cancer surgery
		Evolution of laparoscopy for colorectal cancers
		Evolution of laparoscopic surgery for benign colorectal condition
			Rectal prolapse
			Inflammatory bowel disease
			Diverticular disease
		Laparoscopic colorectal surgery in emergency situations
		Future of laparoscopic colorectal surgery
		Summary
		Key points
		References
	2. Training for Laparoscopic Colorectal Surgery
		Learning objectives
		Introduction
		Laparoscopic surgery in colorectal diseases
		Knowledge of basic laparoscopic surgical skills
		Learning tools, techniques and methodologies
			Animal and human cadaver training models
			Endotrainer box
			Virtual reality simulators
			Training in a specialized colorectal unit
		Standard training models for teaching advanced laparoscopic skills in colorectal surgery
			General surgery apprenticeship and traineeship programmes
			Fellowships in MAS or advanced laparoscopy
			Master class or dedicated fellowship courses
			Preceptorship and proctorship
			Highly structured training courses
				LAPCO programme
		Training of a laparoscopic colorectal surgeon
		Summary
		Key points
		References
	3. Clinical Anatomy Related to Laparoscopic Colorectal Surgery
		Learning objectives
		Introduction
		Embryological development of the colon and rectum
		Vascular anatomy of colon and rectum
			Arterial supply
			Venous drainage
		Lymphatic drainage of the colon and rectum
		Fascias of colon and rectum
		Posterior relationships of colon
		Summary
		Key points
		References
	4. Basic Principles and Techniques of Laparoscopic Colorectal Surgery
		Learning objectives
		Introduction
		Potential benefits of laparoscopic colorectal surgery
		Training in laparoscopic colorectal surgery
		Basic principles of laparoscopic colorectal surgery (see Videos 1 and 2)
		Patient preparation
		OR setup
		Standard port placements
		Initial entry and initial assessment
		Instrumentation
		Energy sources
		Staplers and accessories (see Video 3)
		Standard operative steps
			Laparoscopic ileocaecal resection or right hemicolectomy for ileocaecal tuberculosis
			Laparoscopic suture rectopexy for rectal prolapse
			Laparoscopic sigmoid colectomy for sigmoid colon cancer
			Laparoscopic APR for ultra-low rectal cancers
			Laparoscopic anterior resection and low anterior resection for rectal cancers
			Laparoscopic left hemicolectomy for descending colon cancer
			Laparoscopic right hemicolectomy for right colon cancer
			Laparoscopic transverse colectomy
			Laparoscopic restorative proctocolectomy and ileal pouch anal anastomosis
			Laparoscopic total colectomy and ileorectal anastomosis
			Laparoscopic total proctocolectomy and ileostomy
			Laparoscopic reversal of Hartmann.’.s operation
			Laparoscopic colon replacement for corrosive strictures
		Newer techniques and adjuncts
			Intersphincteric dissection and coloanal anastomosis
			Transvaginal/transanal specimen removal
			Proximal diversion
			Neoadjuvant chemoradiation
			Adjuvant chemotherapy
		Conversion in laparoscopic colorectal surgery
		Complications of laparoscopic colorectal surgery
		Summary
		Key points
		Videos
		References
	5. Patient Selection
		Learning objectives
		Introduction
		Why selection of patient is essential?
		Summary
		Key points
		References
	6. Stoma and Its Complications
		Learning objectives
		Introduction
		Stoma marking, counseling, and consenting
		Indications for temporary stoma
			Ileostomy versus colostomy
		Preoperative oral antibiotics and mechanical bowel preparation
		Anastomotic leak
		Role of rectal drains to prevent stoma
		Stoma care
			Stoma complications
				Mucocutaneous separation
				Retraction/flush stoma
				Bowel obstruction
				Stenosis
				Prolapse
				Parastomal hernia
				Granulomas
				Pancaking
				High-output ileostomy
				Peristomal skin excoriations and infections
		Stoma closure and its complications
		Summary
		Key points
		Video
		References
Section II: Perioperative Care of Patient
	7. Bowel Preparation in Colorectal Surgery
		Learning objectives
		Introduction
		The evidence
		History of bowel preparation in colorectal surgery
		Guidelines
		Types of bowel preparation
			Mechanical bowel preparation
			Mechanical bowel preparation and oral antibiotic prophylaxis
			Oral antibiotics alone
			MOABP with IV antibiotics
			Phosphate enemas
			Contraindications for bowel preparation
		Summary
		Key points
		References
	8. ERAS in Colorectal Surgery
		Learning objectives
		Introduction
		Components of ERAS protocols and current recommendations
		Summary
		Key points
		References
	9. Anesthetic Management of Laproscopic Colorectal Surgery
		Learning objectives
		Introduction
		Preoperative assessment and optimization
		Preoperative preparation
		Physiological changes occurring during laparoscopic surgery
			Effect on respiratory system
			Effect on cardiovascular system
			Renal and metabolic effect
			Gastrointestinal effect
		Anesthetic techniques and intraoperative monitoring
			Goal-directed fluid therapy
			Blood transfusion
		Recovery
		Pain control
		Morbidity and mortality
		Summary
		Key points
		References
	10. Complications in Laparoscopic Colorectal Surgery
		Learning objectives
		Introduction and incidence
		Classification of complications
		Small bowel and duodenal injury
		Splenic injury
		Pancreatic and gastric injury
		Major vessel injury
		Surgical site infection
		Wound disruptions
		Early postoperative small bowel obstruction and postoperative ileus (see Video 17)
		Presacral bleeding
		Ureteral injury
		Bladder injury
		Urethral injury
		Urinary dysfunction
		Sexual dysfunction
		Female infertility
		Minor bleeding
		Major bleeding
		Anastomotic dehiscence and leaks
		Chronic presacral sinus
		Strictures
		Fistulas
		Summary
		Key points
		Video
		References
Section III: Laparoscopy in Benign Colorectal Diseases
	11. Laparoscopic Ileocecal Resection
		Learning objectives
		Introduction
		Applied anatomy and physiology of the ileocecal area
		Indications
		Contraindications
		Difference in resection between benign and malignant indications
		Preoperative preparation
		Results and consequences of resection
		Summary
		Key points
		Video
	12. Laparoscopic Appendectomy
		Learning objectives
		Introduction
		Indications
		Absolute contraindications
		Relative contraindications
		Selection of patients
		Preoperative preparation
		OR setup
		Operative steps (see Video 8)
		Postoperative course and recovery
		Postoperative complications
		SILS appendicectomy
		Advantages of laparoscopic surgery
		Disadvantages of laparoscopic surgery
		Summary
		Key points
		Video
		References
	13. Laparoscopic Sigmoid Colectomy for Diverticulitis
		Learning objectives
		Introduction
		Acute diverticulitis
		Diagnosis of acute diverticulitis
		Management of acute complicated diverticulitis
		Choice of procedure
		Laparoscopic versus open approach
			Advantages of laparoscopy in an acute setting
			Disadvantages of laparoscopy in an acute setting
			Prerequisites for laparoscopy in an acute setting
			Technical challenges in laparoscopy in the acute setting
		Laparoscopic lavage in acute diverticulitis
			Literature review
			Patient positioning
			Port placement
			Operative steps
			Complications
			Conversion to laparoscopic colectomy
		Laparoscopic sigmoid colectomy in acute diverticulitis
			Operative steps
			Complications
		Summary
		Key points
		Video
		References
	14. Laparoscopic Rectopexy for Rectal Prolapse
		Learning objectives
		Introduction
		Historical perspective
		Types of rectal prolapse
		Oxford rectal prolapse grading system (ORPG)
		Indications for surgery
		Goals of surgery
		Surgical options
		Selection of approach and controversies
		Preoperative evaluation
		Preoperative preparation
		Operative principles for posterior suture/mesh/resection rectopexy
		OR setup
		Port placements
		Operative steps of laparoscopic suture/resection rectopexy
		Operative techniques
		Postoperative care and early outcomes
		Postoperative complications
		Long-term functional results
		Robotic rectopexy
		Summary
		Key points
		Videos
		References
	15. Laparoscopic-Assisted Stomas and Stoma Reversal
		Learning objectives
		Laparoscopic stoma formation
		Loop ileostomy
		Loop stoma reversal (see Videos 5 and 6)
		Colostomy
			Sigmoid colostomy
			Transverse colostomy
			Sigmoid stoma reversal (Hartmann.’.s reversal)
			Operative approach
			SILS stoma
		Complications
		Summary
		Key points
		Videos
		References
	16. Laparoscopic Restorative Proctocolectomy and Ileal Pouch Anal Anastomosis
		Learning objectives
		Introduction
		Goals of surgery
		Surgical options
		Selection of patients
		Indications for RPC-IPAA
		Contraindications for RPC-IPAA
		Advantages of RPC-IPAA
		Disadvantages of RPC-IPAA
		Operative principles of laparoscopic assisted RPC-IPAA
		Preoperative preparation
		Operative steps
			OR setup
			Port placement philosophy
			Operative technique
		Postoperative care and usual recovery
		Postoperative complications – early and late
			Pouchitis
			Pouch failure
			Stricture
			Fecal incontinence
			Pouch dysplasia/cancer
			Sexual dysfunction
			Female infertility
			Anal transition zone inflammation
			Anal transitional zone dysplasia
		Functional results of RPC-IPAA
		Controversies
		Authors’ experience
		Summary
		Key points
		Videos
		References
	17. Parastomal Hernias
		Learning objectives
		Introduction
		Incidence of PH
		History of laparoscopy in stomal surgery
		Classification of PH
		Risk factors
		Diagnosis of PH
		Indications and contraindications for surgery
		Surgery for PH
		Prevention of parastomal hernia
			Transrectus or pararectus
			Size of the trephine
			Extraperitoneal approach
			Role of prophylactic mesh
		Techniques of repair
		Onlay mesh repair
		Intraperitoneal mesh repair
		Laparoscopic versus open repair (see Videos 15 and 16)
		Recurrence
		Recurrent PH repair
		Robotic PH repair
		Summary
		Key points
		Videos
		References
Section IV: Laparoscopy Colorectal Cancer Surgery
	18. Laparoscopic versus Open Colorectal Resection: an Evidence-Based Review
		Learning objectives
		Introduction
		Historical perspectives of laparoscopic colorectal surgery
		Filling the gap between open and laparoscopic surgery
			Laparoscopic-assisted techniques
			Hand-assisted techniques
		Evidence for quality of life after laparoscopic colorectal cancer resection
		Rectal cancer
			Efficacy of minimal invasive surgery for rectal malignancy
			Locally advanced rectal disease
				Indications for extended lymphadenectomy in rectal cancer
		Future of laparoscopic colorectal surgery
		Summary
		Key points
		References
	19. Laparoscopic Right Hemicolectomy for Right Colon Cancer
		Learning objectives
		Introduction
		Definition
		Indications
		Preoperative work up
		Operative technique (see Videos 18 and 19)
			Positioning and port placement
		Operative steps
		Postoperative care
		Role of SILS (single incision laparoscopic surgery)
		Summary
		Key points
		Videos
		References
	20. Laparoscopic Transverse Colectomy for Transverse Colon Cancer
		Learning objectives
		Introduction
		Anatomy
		Evidence of laparoscopic resection
		Preoperation preparation
		Steps of laparoscopic transverse colectomy
			Port placement (.Figure 20.2.)
			Greater omentum dissection
			Ligation of the middle colic vein and artery
			Mobilization of the mesocolon
			Delivery of the colon
		Summary
		Key points
		References
	21. Laparoscopic Hemicolectomy for Left Colon Cancer
		Learning objectives
		Introduction
		Vascular anatomy of the left colon
		Lymphatic drainage of the left colon
		Complete mesocolic excision (CME)
		Resection templates for left colon cancer
		Laparoscopic left hemicolectomy: Surgical technique (see Video 31)
		Surgical steps
		Summary
		Key points
		Video
		References
	22. Laparoscopic Anterior Resection and Total Mesorectal Excision for Rectosigmoid Cancer
		Learning objectives
		Introduction
		Preoperative patient preparation
		Operating room: Patient position and draping with placement of equipment and team
			Position of the patient
			Position of the surgeon and equipment
		Initiating the procedure: Port placement and laparoscopic instrumentation (see Video 20)
			Port placement
			Instruments required
		Performing the procedure
			Medial to lateral dissection: Inferior mesenteric vein ligation
			Medial to lateral dissection: Mesocolic dissection
			Ligation of inferior mesenteric artery
			Enter the lesser sac
			Haray maneuver and posterior pelvic dissection
			Lateral peritoneal dissection and mobilization of splenic flexure
			Back to pelvic dissection (anterior and lateral dissection)
			Distal rectal transection and anastomosis of the rectum
			Extracorporeal procedure
			Summary
		Key points
		Videos
		References
	23. Techniques for Laparoscopic Low Anterior Resection, Ultra Low Anterior Resection, and .Inter Sphincteric Resection (ISR)
		Learning objectives
		Introduction
		Indications
		Contraindications
		Laparoscopic total mesorectal excision
			Preoperative preparation
			Theater setup: Patient position (see Videos 21 and 22)
			Ports position (.Figure 23.1.)
			Technique
				Exploration of peritoneal cavity
				Division of the inferior mesenteric pedicle (medial to lateral approach)
				Medial to lateral mobilization of descending colon, splenic flexure, and transverse colon
				Mobilization of lateral attachments of rectosigmoid and descending colon
				Splenic flexure and transverse colon mobilization
				Pelvic dissection
				Posterior mobilization
				Medial and lateral mobilization
				Anterior mobilization
				Distal occlusion
				Rectal transection
				Specimen removal
				Anastomosis (.Figure 23.9.)
				Assessment of anastomosis
			Intersphincteric resection
			Diversion ileostomy
			Postoperative care
		Postoperative follow-up
		Discussion
		Summary
		Key points
		Videos
		References
	24. Laparoscopic Conventional Abdominoperineal (CAPE) and Extra-Levator Abdominoperineal Resection (ELAPE)
		Learning objectives
		Indications
		Risk factors
		Staging workup (with emphasis on how MRI helps in loco-regional staging and preoperative planning)
		Function after low anterior resection, and low anterior resection syndrome (LARS)
		Surgical considerations
			LAR versus APR, sphincter preservation
			Conventional APR versus ELAPE
			ELAPE in supine versus prone position
				Perineal closure in ELAPE
				Pelvic floor reconstruction after ELAPE
				Laparoscopic ELAPE
			Preoperative preparation (see Videos 23 and 26)
				Steps of the procedure: Tips and tricks
				Options for perineal reconstruction
				Sacrectomy
			Maintaining intestinal continuity after APE
		Quality of life (QOL) issues
			Laparoscopic versus robotic rectal cancer surgery
		Summary
		Key points
		Videos
		References
	25. Laparoscopic Subtotal/Total/Proctocolectomy
		Learning objectives
		Introduction
		Definition
		Indications
			Synchronous colon cancer
			Lynch syndrome
			Obstructed left sided colon cancers
			Familial adenomatous polyposis (FAP)
			Ulcerative colitis
			Crohn’s disease
			Chronic severe constipation
		Contraindications
		Summary
		Key points
		References
	26. Laparoscopic Management of T4 Tumor and Pelvic Exenteration for Locally Advanced Tumors
		Learning objectives
		Introduction
		What is T4 colorectal cancers or LACRC?
		Clinical presentation
		Preoperative evaluation
		Colonoscopy
		Radiological imaging
		Selection of patients for neoadjuvant chemoradiation
		Role of laparoscopy and surgical technique for T4 colorectal cancers/LACRC
		Key operative steps in routine laparoscopic colorectal surgery
		Key differences in operative steps in T4 or LACRC
		In male patients
		Specimen retrieval and formation of ileal conduit and stapler anvil head insertion in male patients
		In female patients
		Special situations
		Summary
		Key points
		References
	27. Laparoscopic Surgery in Obstructed and Recurrent Tumors
		Learning objectives
		Introduction
		Clinical presentation
		Management
		Treatment
			Laparoscopic surgery in obstructed colorectal cancers
			Laparoscopic surgery in recurrent colorectal cancers
				Risk factors for recurrence
		Classification of recurrences
		Key steps for a safe surgery
		Palliative resection
		Postoperative care and follow-up
		Summary
		Key points
		References
	28. Resection for Colorectal Liver Metastasis
		Learning objectives
		Introduction
		Evaluation of resectability
		Management of resectable liver metastasis
			Timing of resection for synchronous liver metastases
			Laparoscopic major (right/left) hepatic resection [29.]
			Laparoscopic left lateral sectionectomy
			Laparoscopic segmentectomies/Nonanatomical resections
		Radiofrequency ablation
		Management of unresectable liver metastasis
		Outcomes of laparoscopic resection for CRLM
		Management flowchart for colorectal liver metastases [.28.]
		Summary
		Key points
		References
	29. Specimen Retrieval after Laparoscopic Colectomy and NOSE
		Learning objectives
		Introduction
		Mini-laparotomy or convenient incision
		Criteria for site selection (.Table 29.1.)
		Transabdominal
			BMI
			Type of incisions for retrieval
		Issues with mini-laparotomies
		NOSE
		Background
		Selection factors for NOSE
			Patient factors
				BMI
				Sex
			Anatomic location
			Specimen factors
		Other potential factors
		Summary
		Key points
		References
Section V: Robotic Colorectal Surgery
	30. Robotic Colonic Cancer Surgery
		Learning objectives
		Introduction
		Equipment
		General principles
		Right hemicolectomy
		Left and sigmoid colectomy
		Transverse colectomy
		Robotic colectomy in the era of complete mesocolic excision (CME)
		Summary
		Key points
		References
	31. Robotic Rectal Cancer Surgery
		Learning objectives
		Introduction
		Preoperative preparation and precautions
		Position, port placement, and instrumentation
		Steps of surgery
			Nerves
			Margins
			Vascularity
		Robotics in rectal cancer
			Conversion rate
			Learning curve
			Short-term clinical outcomes
			Sexual and urinary functions
		Oncological outcomes
		Cost
		Advantages of robot-assisted TME for rectal cancer
		Summary
		Key points
		Videos
		References
Section VI: Transanal Surgery
	32. Transanal Minimally Invasive Surgery (TAMIS)
		Learning objectives
		Introduction
		Indications
		Reach of TAMIS
		Risks of TAMIS
		Contraindications
			Evaluation of the lesion
			Preparation of the lesion
			Bowel preparation
			Deep venous thrombosis prophylaxis
			Prevention of urinary retention
			Equipment and operative set-up
		Equipment: Articulated stabilizing arm
			Operative proctoscopes
			Optics
			Long instruments
			Insufflator/suction/irrigation/light/electrocautery machines
		Adaptable laparoscopic instruments
			Harmonic scalpel
			LigaSure
		Resection options
			Mucosectomy
			Partial rectal wall excision
			Full-thickness excision
			Full-thickness excision with perirectal fat
		Procedure (see Video 34)
		Complications
			Peritoneal entry
			Bleeding
			Dehiscence
			Conversion to laparotomy
			Urinary
			Anal incontinence
			Recto-vaginal fistula
		Summary
		Key points
		Video
		References
	33. Transanal Total Mesorectal Excision for Rectal Cancer
		Learning objectives
		Transanal TME history and results
		Preoperative evaluation
			Indications and contraindications
		Preoperative assessment
		Operative approach
		Positioning (see Video 35)
		Abdominal dissection
		Transanal dissection
		‘Rendez-vous’
		Anastomosis
		Complications of taTME
			Urethral injury
			Carbon dioxide embolism
			Anastomotic leaks
		Summary
		Key points
		Videos
		References
	34. Combined Endoscopic-Laparoscopic Surgery (CELS) for Colorectal Polypectomy
		Learning objectives
		Introduction
		CELS polypectomy surgical technique
		Benefits and limitations of CELS polypectomy
		Current research on CELS polypectomy
		Summary
		Key points
		References
Section VII: Hand-Assisted and Single-Incision Laparoscopic Colorectal Surgery
	35. Hand-Assisted Laparoscopic Colorectal Surgery
		Learning objectives
		Introduction
		HAL colorectal resections
		Indications
		Preoperative preparation
		Surgical instruments
		Surgical steps (see Video 36)
		Position
		Incision and trocar placement (.Figure 35.2.)
			Camera port
			Working port
		Surgical procedure
		Modifications
		Summary
		Key points
		Video
		References
	36. Single-Incision Laparoscopic Colorectal Surgery
		Learning objectives
		Introduction
		SILS ports and equipment
		Robotic SILS
		Single-incision laparoscopic appendectomy
			Surgical tips
		Single-incision laparoscopic right hemicolectomy (see Videos 38 and 39)
			Surgical tips
		Single-incision laparoscopic left hemicolectomy
			Surgical tips
		Single-incision laparoscopic anterior resection
		Single-incision laparoscopic total colectomy
			Surgical tips
		Summary
		Key points
		Videos
		References
Index