Recent Concepts in Minimal Access Surgery: Volume 1

Foreword
Preface
Acknowledgements
Contents
About the Editor
Laparoscopic Nissen’s Fundoplication for GERD: Current Perspective
	Introduction
	Clinical Presentation
		Medical vs Surgical Therapy
	Fundoplication
		Introduction
		Antireflux Barrier Mechanism and Fundoplication
		Indications of Surgery
		The Preferred Approach: Open vs Laparoscopic?
		Role of Fundoplication in NERD
		Role of Fundoplication in Obesity
		Current Controversies Related to the Technique of Laparoscopic Fundoplication
		The Key Components of Fundoplication as Recommended Are as Follows:
		The images of the aforementioned steps as performed: (Figs. 1, 2, 3, 4, 5, 6 and 7)
			Complete vs Partial Wrap
			Division vs Non-Division of Short Gastric Vessels
			Crural Closure
			Mesh vs Suture Closure of Hiatus Hernia
			Role of Bougie Dilators
			Redo Fundoplication
	Newer Modalities
		Robotic Fundoplication
		Magnetic Ring Implants (LINX™ Procedure)
	Conclusion
	Editor’s Note
		Insertion of the Bougie Across the Esophageal Junction
		LES Electrical Stimulation
		Laparoscopic Sleeve Fundoplication
		Endoscopic Fundoplication/Transoral Incisionless Fundoplication
		Stretta Procedure
		Quality of Life
		References for Editor’s notes
	References
Recent Advances in Laparoscopic Gastrectomy for Gastric Cancer with Special Reference to D2 Lymphadenectomy
	Introduction
	Extent of Gastrectomy and Different Minimally Invasive Approaches of Laparoscopic Gastrectomy
		Hand-Assisted Laparoscopic Gastrectomy (HALG)/LADG Laparoscopic Assisted Digital Gastrectomy
		Laparoscopy-Assisted Gastrectomy (LAG)
		Totally Laparoscopic Gastrectomy (TLG)
		Laparoscopic Function-Preserving Surgery
		Single-Incision Distal Gastrectomy (SIDG)
		Robotic Gastrectomy
	D1 Versus D2 Lymphadenectomy
	Comparison of Open Vs Laparoscopic Gastrectomy
	Surgical Technique
		Patient Position, Trocar Location and Performance of Staging Laparoscopy
		D2 Lymphadenectomy and Specimen Resection for Distal and Total Gastrectomy
	Gastrointestinal Reconstruction after Distal Gastrectomy
		Drain Placement and Closure
	Perioperative Management
	Complications
	Conclusion
	Editor’s Note
		Laparoscopic Versus Open D2 Gastrectomy
		Variations in Extent of Resection
			Gastrectomy
			Lymphadenectomy
			Additional Organ Excision
		Techniques in Anastomosis
			Anastomotic Techniques after Distal Gastrectomy
			Reconstruction after Proximal Gastrectomy
			Reconstruction after Laparoscopic Total Gastrectomy
		Emerging Use of Laparoscopic Techniques in Early Gastric Cancer
		Sentinel Node Navigation Surgery
		References for Editor’s notes
	References
Laparoscopic Subtotal Cholecystectomy
	Introduction
	History
	Types of Subtotal Cholecystectomies
	Incidence
	Indications
	Technical Variations
	Impact of LSC
	Remnant Cholecystectomy
	LSC & the Risk of GB Cancer
	Conclusion
	Editor’s Note
		Technical Modifications in Difficult Gallbladder and Subtotal Cholecystectomy
			Near Infrared Cholecysto-Cholangiography
			Ultrasonic and Saline Jet Dissection
			Clipless Laparoscopic Cholecystectomy
		Endovesical Approach
			Persistent/Recurrent Symptoms After Subtotal Cholecystectomy and Redo Stump Excision
			Spyglass Cholangioscopy
		References for Editor’s notes
	References
Prediction and Grading Methods of a Difficult Laparoscopic Cholecystectomy
	Introduction
	Definition of Difficult Gallbladder
		Defining a Difficult Gall Bladder Based on Outcome or Procedural Modification
		Defining Difficult Gallbladder Based on Grading and Scoring Systems Using Intraoperative Variables
	Prediction of Difficult Laparoscopic Cholecystectomy
	Patient Selection Criteria in Acute Settings
		Guidelines for Patient Selection in Clinically Diagnosed Acute Cholecystitis or Emergency Cholecystectomy
	Patient Selection in Non-Acute (Chronic) Setting
	Possible Preoperative Clinical Predictors/Indicators of Difficult Laparoscopic Cholecystectomy in Elective Setting
		Parameters Observed in History
		Parameters Observed on Clinical Examination
		Parameters in Abdominal Sonography
		Parameters in Computed Tomography Scan (CT Scan)
		Parameters in MRCP
		Preoperative Interventions
	Intraoperative Parameters Used to Grade Difficulty in LC
		Parameters Related to Disease Process
		Parameters that May be Dependent on Surgeon’s Ability
	Scoring Systems in Grading Difficulty and Their Validation
		Grading Systems Using Preoperative Parameters and their Validation
		Grading Systems Using Primarily Intraoperative Parameters and their Validation
		Grades of Severity and Suggested Treatment
		Utility of the Scoring Systems
	Conclusion
	References
Robotic Assisted Pancreaticoduodenectomy
	Introduction
	Patient Selection
	Technique of Robotic Assisted Pancreaticoduodenectomy [RAPD]
		Diagnostic Laparoscopy
		Opening Gastrocolic Omentum
		Ligation of the Gastrocolic Vessels
		Cattle-Braasch Maneuver [Mobilisation of the Right Colonic Flexure and Extended Kocherization]
		Hilum Exploration
		Gastroduodenal Artery [GDA]Dissection
		Retro Pancreatic Tunnel
		Transection of Stomach
		Pancreatic Neck Transection
		Transection of the Jejunum
		Cholecystectomy
		Transection of the Bile Duct
		Transection of the Uncinate Process of the Pancreas
		Specimen Extraction
		Docking of the Robot for Reconstruction
		Pancreatico-Jejunostomy [PJ]
		Hepatico-Jejunostomy [HJ]
		Undocking of the Robot
		Gastro-Jejunostomy [GJ]
		Abdominal Drain Placement Is Done at Three Sites
	Outcomes After RPD/RAPD
	Complications of Pancreaticoduodenectomy
	Conclusion
	Editor’s Note
		References for Editor’s notes
	References
Laparoscopic Surgery for Rectal Prolapse
	Introduction
	Patient Selection
		Constipation with Rectal Prolapse
		Incontinence with Rectal Prolapse
		Rectal Prolapse in Elderly
	Laparoscopic Surgeries for Rectal Prolapse
		Laparoscopic Resectional Rectopexy
		Procedure
		Laparoscopic Non-Resectional Rectopexy
		Laparoscopic Suture Rectopexy: (Fig. 8)
		Laparoscopic Mesh Rectopexy
		Laparoscopic Ventral Rectopexy
	Robotic Rectal Prolapse Surgery
	Controversies in Rectal Prolapse
		Pre-operative Anal Physiologic Testing
		Abdominal or Perineal Approach to Correction of Prolapsed Rectum
		Posterior Rectopexy or Ventral Rectopexy
	Current Scenario
	Conclusion
	Editor’s Note
	Table EN 1: Comparison [1,2,3]
	Notes and Other Endoscopic Approaches
		NOTES-TEM Approach
		NOTES Endoscopic Rectopexy
		NOTES Combined with TAMIS
	References
Laparoscopic Lymphadenectomy for Colorectal Cancers: Concepts and Current Results
	Introduction
	Nodal Staging
	Techniques of Colorectal Lymphadenectomy
		Current Concepts
		Complete Mesocolic Excision [CME] and Central Vascular Ligation [CVL] with D3 Lymphadenectomy for Right Sided Colonic Cancers
		Total Mesorectal Excision [TME]
		Lateral Lymph Node Dissection [LLND]
		Minimally Invasive LLND
		Sentinel Lymph Node [SLN] Resection
		Modification in Techniques of Sentinel Lymph Node Mapping
	Laparoscopic Right Colonic Resections with CVL
		Advantages of Initial Retro Colic Approach
	Laparoscopic Left Sided Colonic Resections with Total Mesorectal Excision [TME]
		Division of the Rectum
		Advantages of Laparoscopic TME/CME
	Lateral Lymph Node Dissection
	Complications
		Bleeding/Vascular Injury
		Anastomotic Leak
		Chyle Leak
		Severe Complications and Risk Factors for Complications
	Conclusion
	Editor’s Note
		Anatomy
		Variations in Blood Supply and Venous Drainage of Right Colon as Pertinent to Laparoscopic Right Hemicolectomy
		Emryological Fusion Planes Encountered in Laparoscopic Right Hemicolectomy
		Metaanalyses on Mesocolic Excision Versus Non Mesocolic Excision
		Meta Analyses on Laparoscopic and Open Mesocolic Excision
		Meta Analyses on Lateral Lymph Node Dissection in Rectal Cancers
		Metaanalyses on Sentinel Lymph Node Biopsy in Colorectal Cancers
		References for Editor’s notes
	References
Ergonomics in Laparoscopic Surgery: An Appraisal of Evidence
	Introduction
	Literature Related to Ergonomics
	Doctor and Patient Related Consequences of Improper Ergonomics in Laparoscopic Surgery
	Why and How Ergonomics of Laparoscopic Surgery is Different from that of Open Surgery
	Critical Adjustments for Improving Ergonomics in Laparoscopic Surgery
		1. Work Place Layout
		2. Tool (instrument) design and use: Ergonomic Deficiency in Design and Function of Laparoscopic Tools
		The Critical Adjustments in Tool Design and Use
		3. Work Environment Modification
	4. Training of Staff
		Trunk Muscle Training, Posture Fatigue, and Performance in Laparoscopic Surgery
		Ergonomics: Laparoscopy Versus NOTES/SILS/Robotics
	Conclusion
	References
Surgical Meshes Used in Laparoscopic Procedures
	Introduction
	History
	Tissue Engineering Principles of Mesh Design
	Biocompatibility
	Mechanical Properties
		Tensile Strength
		Elasticity
		Stiffness
		Pore Size and Weight
		Weight
		Degradation
		Constitution
		Anisotropy
	Classification of Meshes
		Uncoated Meshes (Fig. 2)
		Coated or Barrier Meshes
		Biological Meshes (Fig. 5)
		Other Newly Engineered Meshes (Fig. 6)
	Complications
		Hernia Recurrence
		Mesh Infection
		Adhesion
		Postoperative Pain
		Other Mesh: Related Complications
	Characteristics of an Ideal Mesh
	Conclusions
	References
Staging Laparoscopy in Intra-Abdominal Cancers
	Introduction
	Technique of Staging Laparoscopy
	Clinical Applications of Staging Laparoscopy
		Cancer of the Oesophagus
		Gastric Cancer
		Pancreatic Cancer
		Hepatobiliary Cancer
		Gynaecologic Cancer
			Carcinoma Cervix
			Carcinoma Endometrium
			Carcinoma Ovary
	Conclusion
	Editor’s Note
		References for Editor’s notes
	References
Role of ICG Fluoroscence Imaging in Laparoscopic Bowel Anastomosis
	Introduction
	Fluorescence Imaging (FI)
	Clinical Applications of ICG [1]
	Minimal Access Gastro-Intestinal Reconstruction
	Colorectal Surgery
		ICG in Laparoscopic Colorectal Surgery
	Bariatric Surgery
		Role of ICG in Laparoscopic Bariatric Surgery
		Methods
	Future of Fluorescence Imaging
	Conclusion
	References
Minimizing Pain in Laparoscopic Hernia Surgery
	Introduction
	Type of Pain After Hernia Surgery
		Acute and Chronic Post-operative pain
		Pre Peritoneal Repairs
		Laparoscopic Repair
	Modifications to Prevent Acute Post Operative Pain After Laparoscopic Hernia Repair and their Management
	Chronic Pain After Laparoscopic Repair
		Pathogenesis of Chronic Pain After Laparoscopic Repair
		Assessment and Severity of Pain
		Management of Chronic Pain After Laparoscopic Repair
	Conclusion
	References
Extended-View Totally Extraperitoneal Approach (eTEP) for Inguinal Hernia Repair
	Introduction
	Indications of eTEP
	Technical Aspects of the eTEP Approach
		Instruments
		Steps of Surgery
	Conclusion
	References
Mini Gastric Bypass
	Introduction
	Principles and Technique
		Ergonomics and Patient Position
		Creation of Lesser Omental Window
		Antral Division
		Creation of MGB Gastric Pouch
		Bilio-Pancreatic Limb (BPL) Length
		Creation of Gastro-Jejunostomy (GJ)
		Positioning of GJ Stapler
		GJ Closure
		Hemostasis
		Leak Test
	Advantages and Disadvantages of MGB [7]
	Complications
		Early Complication
		Late Complication
	Effect of MGB on Type-2 Diabetes Mellitus (T2DM)
	Future Perspective
	Revision to MGB from Other Procedures
		Laparoscopic Adjustable Gastric Banding (LAGB) to MGB
		Laparoscopic Sleeve Gastrectomy to Mini Gastric Bypass
	Conclusion
	Editor’s Note
		Late Complications
		One Anastomosis Gastric Bypass-Mini-Gastric Bypass (OAGB)
		Diverted Mini Gastric Bypass (dMGB)
		References for Editor’s notes
	References
Robotic Roux-en-Y Gastric Bypass
	Introduction
		Roux-en-Y Gastric Bypass (RYGB)
	Surgical Technique
		Instrumentation (Fig. 1)
		Patient Positioning & OR Setup (Fig. 2)
		Port Position (Fig. 3a, b) and Docking (Fig. 4)
		Creation of Gastric Pouch
		Creation of Jejuno-Jejunostomy (JJ)
		Creation of Gastrojejunsotomy (GJ)
	Perioperative Care
	Outcomes and Results
	Conclusion
	Editor’s Note
		Indications and Complications of RYGB
		Minimally Invasive Surgery Versus Open RYGB
		Laparoscopic Versus Robotic RYGB
		Antecolic Versus Retro Colic RYGB
		Biliary Disease After RYGB
		OAGB (One Anastomosis Gastric Bypass) vs RYGB
		Revisional RYGB
		References for Editor’s notes
	References
Third Space Endoscopy
	Introduction
		What Is Actually the Third Space Endoscopy?
		Per Oral Endoscopic Myotomy (POEM)
	Steps of Poem
	Outcomes of Poem
	Adverse Effects of POEM
	Comparison of POEM vs Laparoscopic Heller’s Myotomy
		Z-POEM (Zenker’s Per Oral Endoscopic Myotomy)
		D-POEM (Diverticulum Per Oral Endoscopic Myotomy)
		G-POEM (Gastric Per Oral Endoscopic Myotomy)
		STER (Sub Mucosal Tunnelling and Endoscopic Resection)
	Conclusion
	Editor’s Note
		Newer Evolving Application of Third Space Endoscopic Techniques
		Results of POEM Versus Laparoscopic Hellers Myotomy
		Techniques to Improve Visualization and Dissection in POEM
		References for Editor’s notes
	References
Endoscopic Management of Pancreatic Fluid Collection
	Introduction
	Classification and Natural History of PFC’S
		Evolving Concepts in Management
		Minimally Invasive Approach
	Specific Technology
		Planning of Intervention in PFCs
		Pre Procedure Investigations
		Percutaneous Catheter Drainage and Necrosectomy
	Endoscopic Drainage of PPC
		Various Endoscopic Approaches in PFC’s
		Factors that Influence the Route of Endoscopic Drainage
	Endoscopic Transmural Drainage of PFC
		Preprocedure Preparation
		Esophago Gastro Duodenoscopy (EGD) Based PFC Drainage
		EUS Guided Transmural PFC Drainage (Fig. 5)
		Brief Outline of the Standard Steps of the EUS Guided Transmural Drainage
		Complications and Outcome
	Transpapillary Drainage of PFC (Fig. 6)
		Need of Pre Drainage ERCP (Pancreatogram)
		Transpapillary Drainage (ERCP Guided)
		Disadvantages of Transpapillary Approach
	Combined Approach for Drainage of PFCs
	Choice of Stents, Plastic Versus Metallic Stents
		SEMS (Self-Expanding Metal Stents) and LAMS (Lumen Apposing Metal Stents)
	Endoscopic Management of WON and Endoscopic Necrosectomy (Figs. 7, 8, and 9)
		Indications and Factors Deciding the Timing of Necrosectomy
	Direct Endoscopic Necrosectomy (DEN)
	Complications
	Conclusion
	Editor’s Note
		Endoscopic Versus Percutaneous Drainage
		Laparoscopic Versus Endoscopic Drainage
		Transphincteric Stenting in Transmural Drainage
		Plastic Versus Metallic Stents
		References for Editor’s notes
	References
Management of Solitary Pulmonary Nodule
	Introduction
	Solid and Subsolid Nodules
	Approach to a SPN
	Risk Assessment for Malignancy Based on Clinicoradiological Parameters
		Risk Prediction Models: Brock University Model and Herder Model
	Surviellance of Solid SPN
		Key BTS Recommendations on Surveillance [1, 8]
	Management of Subsolid Nodules (SSNs)
		Key BTS Recommendations for Management of SSNs [1, 8]
	Biopsy Techniques
	Surgical and Non-Surgical Treatment
		Surgical Approach: Thoracotomy Vs Thoracoscopy Vs Robotics
		Extent of Resection- Lobar Vs Sub-Lobar Resection
		Key BTS Recommendations on Surgery (Fig. 8) [1, 8]
		Localization Techniques for Nodules (Table 4)
		Nonsurgical Treatment Without Pathological Confirmation
		Key BTS Recommendations for Non-surgical Treatment [1, 8]
	Editor’s Note
		References for Editor’s note
	References
Minimally Invasive Thymectomy
	Introduction
	Indications
		Indications of Thymectomy
	Classification of Thymectomy
	Preoperative Evaluation
		Preoperative Preparation
	Operative Technique
	Robot Assisted VATS Thymectomy
		Operative Setup
		Operative Technique (Left Side Approach)
	Pearls and Technical Aspects of VATS
	Post-Operative Care
	Advantages of VATS
	Limitations/Contraindications of VATS Thymectomy
	VATS Variants and Future
		Single Incision Minimally Invasive Thoracic Surgery
		Future
		Non-intubated Uniportal VATS Thymectomy
	Outcomes of VATS Versus Open Thymectomy
	Outcomes of Robotic Versus Nonrobotic VATS Thymectomy
	Conclusion
	Editor’s Note
		References for Editor’s notes
	References
Retroperitoneoscopic Minimally Invasive Adrenalectomy
	Introduction
		Anatomy and Physiology
		History
	Minimal Access Adrenalectomy
	Posterior Retro-Peritoneal Approach
		TECHNIQUE: Posterior Approach
		Special Concerns of Posterior Approach
		TECHNIQUE: Lateral Approach
	Posterior vs Lateral Approach
	Reasons for Conversion
	Complications of Retroperitoneal Adrenalectomy
	Comparison of Retroperitoneal with Other Approaches
	Role of ICG in Minimally Invasive Adrenalectomy
		ICG in Delineation of Vascular Anatomy
		ICG in Adrenal Sparing Surgeries for Bilateral Disease and Reoperations
	Conclusion
	Editor’s Note
		Adrenalectomy
			Approach
			Risk Factors for Complications
			Minimally Invasive Retroperitoneal Adrenalectomy in Phaeochromocytoma
			Minimally Invasive Adrenalectomy in Malignancies
			Minimally Invasive Adrenalectomy for Isolated Adrenal Metastases
			Minimally Invasive Retroperitoneoscopic Adrenalectomy in Large Adrenal Tumors
			BMI and Retroperitoneal Adrenalectomy
			Meta-Analysis Comparing Transperitoneal Versus Retroperitoneal Adrenalectomy
			Robotic Adrenalectomy: Meta-Analyses Comparing Robotic and Laparoscopic Adrenalectomy
		Investigational Adjuncts and Technique Modifications in Minimal Access Adrenalectomy
			Single Site Adrenalectomy/Single Incision Retroperitoneal Adrenalectomy
			Single Plane Retroperitoneoscopic Adrenalectomy
			Hand Assisted Retroperitoneal Adrenalectomy
			Intraperinephric Fat Versus Extraperinephric Fat Approach
			Clipless and Suture Less Laparoscopic Adrenalectomy
			Perioperative Principles of Fast Track Surgery in Retroperitoneal Adrenalectomy
		References for Editor’s notes
	References
Laparoscopic Donor Nephrectomy
	Introduction
	Strategies Adopted to Increase Organ Donation
	Surgical Techniques
		Laparoscopic Donor Nephrectomy (LDN): Left Kidney
		Drawbacks of LDN
		LDN vs ODN
	Hand-Assisted LDN
	Right vs Left Kidney for LDN
	Laparoscopic Donor Nephrectomy (LDN): Right Kidney (Fig. 7)
	Endoscopic Retroperitoneal Donor Nephrectomy (ERDN)
	Single-Port Laparoscopic Donor Nephrectomy (SPLDN)/Laparoendoscopic Single Site Donor Nephrectomy (LESS-DN)
	Robotic Assisted Donor Nephrectomy (RADN)
	Complications
	Conclusion
	Editor’s Note
		References for Editor’s notes
	References