CURRENT REVIEW OF

Minimally INVASIVE SURGERY

CURRENT REVIEW OF

Minimally INVASIVE SURGERY

Edited by

DAVID C. BROOKS, MD Associate Professor of Clinical Surgery Harvard Medical School Brigham and Women's Hospital Boston, Massachusetts

With 44 Contributors

Springer

Current Medicine, /ne. 400 Market Street, Suite 700 Philadelphia, PA 19106

Director, Product Development: Lori J. Bainbridge Developmental Editor: Elizabeth Rexon Art Director: Paul Fennessy Design: Patrick Ward Layout: Christine Keller-Quirk, Erika Mangan, and Patrick Ward 11/ustration Director: Ann Saydlowski lflustrators: Beth Starkey, Lisa Weischedel, and Debra Wertz Production Manager: Lori Holland Typesetter: Ryan Walsh

ISBN 978-1-4612-7247-2 ISBN 978-1-4612-1692-6 (eBook)

DOI 10.1007/978-1-4612-1692-6

54321

© Copyright 1998 by Springer-Verlag Berlin Heidelberg

SPIN 10645056

Originally published by Springer-Verlag Berlin Heidelberg New York in 1998

Ali rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise, without prior written permission of the publisher.

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with the prescribing physician. Neither the publishers nor the author can be held responsible for errors or for any consequences arising from the use of the informa­tion contained therein. Any product mentioned in this publication should be used in accordance with the prescribing information prepared by the manufacturers.

No claims or endorsements are made for any drug or compound at present under clinica! investigation.

Contributors JOSEPH F. AMARAL, MD Associate Professor of Surgery Department of Surgery Brown University Rhode Island Hospital Providence, Rhode Island

JORGE BALLI, MD Assistant Professor of Surgery Department of Surgery Hospital San Jose - ITESM Monterrey, Mexico; Texas Endosurgery Institute San Antonio, Texas

K. BHAVANI-SHANKAR, MD Fellow Department of Anesthesia Harvard Medical School Brigham and Women's Hospital Boston, Massachusetts

DAVID C. BROOKS, MD Associate Professor of Clinical Surgery Department of Surgery Harvard Medical School Brigham and Women's Hospital Boston, Massachusetts

L. MICHAEL BRUNT, MD Associate Professor Department of Surgery Washington University School of Medicine St. Louis, Missouri

MARK P. CALLERY, MD Associate Professor Department of Surgery and Cell Biology University of Massachusetts Medical School University of Massachusetts Medical Center Worcester; Massachusetts

FRANK H. CHAE, MD Assistant Professor Department of Surgery University of Colorado School of Medicine Denver, Colorado

ALBERT K. CHIN, MD Vice President of Research and Founder Guidant Corporation, Origin Medsystems Inc. Menlo Park, California

JOHN MORGAN COSGROVE, MD Assistant Professor of Surgery Department of General Surgery Albert Einstein College of Medicine Bronx, New York; Director of Laparoscopy/Minimally Invasive

Surgery Long Island Jewish Medical Center New Hyde Park, New York

MALCOLM M. DECAMP, jR., MD Assistant Professor of Surgery Department of Thoracic Surgery Harvard Medical School Brigham and Women's Hospital Boston, Massachusetts

TIMOTHY M. FARRELL, MD Endoscopic Surgery Fellow Department of Surgery Emory University School of Medicine Atlanta, Georgia

STEVEN j. FISHMAN, MD Instructor in Surgery Department of Surgery Harvard Medical School Children's Hospital Boston, Massachusetts

RAJA M. FLORES, MD Fellow Department of Thoracic Surgery Harvard Medical School Brigham and Women's Hospital Boston, Massachusetts

MORRIS E. FRANKLIN, jR., MD Professor of Surgery Department of Surgery University of Texas Health Sciences Center,

San Antonio Director, Texas Endosurgery Institute San Antonio, Texas

GEORGE GALLOS, BS Medical Student Albert Einstein College of Medicine Bronx, New York

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SHAWN M. GARBER, MD Adjunct Instructor/Fellow Department of Surgery The George Washington University Medical

Center Washington Institute of Surgical Endoscopy Washington, DC

JOHN G. HUNTER, MD Professor Department of Surgery Emory University School of Medicine Atlanta, Georgia

PATRICK G. JACKSON, MD Clinical Fellow in Surgery Harvard Medical School Massachusetts General Hospital Boston, Massachusetts

MICHAEL T. jAKLlTSCH, MD Instructor of Surgery Department of Thoracic Surgery Harvard Medical School Brigham and Women's Hospital Boston, Massachusetts

FERENC A. jOLESZ, MD Professor in Radiology Department of Radiology/MRI Harvard Medical School Brigham and Women's Hospital Boston, Massachusetts

JOHN j. KELLY, MD Assistant Professor Department of Surgery University of Massachusetts Medical School University of Massachusetts Medical Center Worcester, Massachusetts

KENNETH A. KERN, MD Associate Professor of Clinical Surgery Department of Surgery University of Connecticut School of

Medicine Farmington, Connecticut; Attending Surgeon Hartford Hospital Hartford, Connecticut

JOACHIM KETTENBACH, MD Research Fellow Image-Guided Therapy Program Department of Radiology Harvard Medical School Brigham and Women's Hospital Boston, Massachusetts; Instructor University Hospital of Vienna Vienna, Austria

RON KIKINIS, MD Assistant Professor Department of Radiology Harvard Medical School Brigham and Women's Hospital Boston, Massachusetts

MARY E. KLINGENSMITH, MD Senior Resident Department of Surgery Harvard Medical School Brigham and Women's Hospital Boston, Massachusetts

MICHAEL F. KUTKA, MD Fellow Department of Surgery Johns Hopkins University Medical School Baltimore, Maryland

D.E.M. LITWIN, MD, FRCSC Associate Professor Department of Surgery University of Massachusetts Medical School Director, Minimally Invasive Surgical Services University of Massachusetts Medical Center Worcester; Massachusetts

WILLIAM E. LORENSEN, MS GE Corporate Research and Development Niskayuna, New York

KEVIN R. LOUGHLIN, MD Associate Professor Department of Urology Harvard Medical School Brigham and Women's Hospital Boston, Massachusetts

ROBERT C. MciNTYRE, JR., MD Assistant Professor Department of Surgery University of Colorado School of Medicine University Hospital Denver, Colorado

TAKAO OHKI, MD Assistant Professor Chief, Endovascular Program Department of Surgery Division of Vascular Surgery Albert Einstein College of Medicine Montefiore Medical Center Bronx, New York

MICHAEL P. O'LEARY, MD, MPH Assistant Professor Department of Surgery Harvard Medical School Department of Urology Brigham and Women's Hospital Boston, Massachusetts

CLAUDE H. ORGAN, JR., MD Professor of Surgery Department of Surgery University of California Davis Alameda County Medical Center Oakland, California

JOSEPH B. PETELlN, MD Clinical Associate Professor Department of Surgery University of Kansas School of Medicine Shawnee Mission, Kansas

DAVID W. RATTNER, MD Associate Professor of Surgery Harvard Medical School Massachusetts General Hospital Boston, Massachusetts

JONATHAN M. SACKIER, MB, CHB, FRCS Professor of Surgery Department of Surgery The George Washington University Medical

Center Washington Institute of Surgical Endoscopy Washington, DC

ROBERT L. SOARES, JR., MD Clinical Instructor Department of Surgery Brown University Rhode Island Hospital Providence, Rhode Island

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NATHANIEL J. SOPER, MD Professor Department of Surgery Washington University School of Medicine Barnes-Jewish Hospital St. Louis, Missouri

RICHARD A. STEINBROOK, MD Assistant Professor Department of Anesthesia Harvard Medical School Anesthesiologist Brigham and Women's Hospital Boston, Massachusetts

GREGORY V. STiEGMANN, MD Professor Department of Surgery University of Colorado School of Medicine Head, Division of GI, Tumor, and Endocrine

Surgery University Hospital Denver, Colorado

MARK A. TALAMINI, MD Associate Professor Department of General Surgery Johns Hopkins University Medical School Johns Hopkins Hospital Baltimore, Maryland

EDMUND K.M. TSOI, MD Assistant Clinical Professor of Surgery Department of Surgery University of California Davis Alameda County Medical Center Oakland, California

FRANK J. VEITH, MD Professor Department of Surgery Albert Einstein College of Medicine Montefiore Medical Center Bronx, New York

WILLIAM M. WELLS III, PHD Assistant Professor Department of Radiology Harvard Medical School Brigham and Women's Hospital Boston, Massachusetts

Preface In the 4 years since the first edition of this book was pub­lished, there have been major advances in minimally inva­sive surgery. The excitement that general surgeons first experienced with laparoscopic cholecystectomy has been transplanted into a variety of other specialties, all of which have found innovative applications for minimally invasive surgery. Many of the lessons learned in general surgery continue to be applicable, including the importance of sound technical training, the necessity for strict creden­tialing, and the significance of outcome measurement. All of these areas are mandatory in order that we rationally develop and implement new procedures.

This new edition evaluates a variety of the "traditional" general surgicallaparoscopic procedures, such as cholecy­stectomy and common duct exploration, esophageal fun­doplication and myotomy, bowel resection, appendecto­my, and so forth. Likewise, the chapters on urologic and pediatric surgical procedures have been updated. Additionally, in the past decade, anesthesia for minimally invasive procedures has become far more sophisticated and the lessons learned in this area are detailed in a new chapter. These lessons, combined with what we have learned about the physiologic changes that accompany laparoscopy, both in the acute operating room setting as well as the short- and immediate-term effects on the

immune system, are discussed in detail. The field of gas­less laparoscopy is explored thoroughly, and new advances in suturing and tissue approximation are discussed in detail. Finally, medical malpractice suits associated with laparoscopic or minimally invasive procedures have increased dramatically over the past 6 to 8 years, recendy surpassing obstetrical suits. A new chapter discusses the implications of medicolegal aspects of minimally invasive surgery.

In the technical arena there have been advances in a number of areas, which only a few years ago were unheard of To this end there are new chapters on surgery of the thyroid and parathyroid glands, the adrenal and pancreas, and bariatric surgery. Additionally, entirely new disci­plines such as minimally invasive vascular surgery and vir­tual imaging are included.

The revolution in surgical care that began with the introduction oflaparoscopic cholecystectomy 10 years ago has thoroughly changed the way we perform surgery. These changes have not always been as we forecasted, or in the areas in which we forecasted change. Nevertheless, as the revolution proceeds, we continue to challenge sur­gical dogma in an effort to improve outcomes while diminishing the trauma of surgery. This edition hopes to provide a guide to these changes.

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David C. Brooks, M D Boston, Massachusetts

Contents CHAPTER 1 Laparoscopic Cholecystectomy Nathaniel}. Soper

Preoperative Considerations .............................................. 1 Preoperative Care and Anesthesia ......................................... 3 Creation of Pneumoperitoneum and Trocar Insertion ....................... 3 Technique ............................................................... 3 Postoperative Care ....................................................... 9 Results ................................................................... 9

CHAPTER 2

Laparoscopic Choledocholithotomy joseph B. Petelin

Patient Management .................................................... 14 Equipment .............................................................. 15 Surgical Approach ....................................................... 16 Operative Techniques ................................................... 16 Avoidance and Management of Complications ............................ 22 Results ................................................................. 23

CHAPTER 3

Anesthetic Considerations for Minimally Invasive Surgery K. Bhavani-Shankar and Richard A. Steinbrook

Physiologic Consequences of co2 Pneumoperitoneum in Healthy Subjects .................................................... 29

Anesthetic Management ................................................. 30 Complications of Laparoscopic Surgery ................................... 35 Anesthetic Considerations in Mediastinoscopy ............................ 36 Anesthetic Considerations in Thoracoscopy ............................... 37

CHAPTER 4 Minimally Invasive Management of Esophageal Disease Timothy M. Farrell and john G. Hunter

Gastroesophageal Reflux Disease ......................................... 41 Paraesophageal Hernia ................................................... 44 Achalasia and Other Motility Disorders ................................... 45 Esophageal Tumors ...................................................... 48

CHAPTER 5 Laparoscopic Appendectomy john Morgan Cosgrove and George Gallos

Indications .............................................................. 54 Contraindications ....................................................... 54 Equipment .............................................................. 54 Technique .............................................................. 54 Anatomic Hazards ...................................................... 56 Postoperative Management .............................................. 57 Laparoscopic Versus Conventional Appendectomy ........................ 57

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CHAPTER 6 laparoscopic Colon and Small Bowel Surgery Morris E. Franklin, Jr., and Jorge Balli

Technical Advances ...................................................... 63 Status of Current Procedures ............................................. 64 Conditions Easily Treated with Laparoscopy ............................... 66 Clinical Applications ..................................................... 66 Advances in the Field .................................................... 66 Ongoing Studies and Developments ...................................... 67 New Equipment ......................................................... 67

CHAPTER 7

laparoscopy for Staging of Malignancy Patrick G. Jackson and David W. Rattner

Esophageal and Gastric Cancer ........................................... 69 Hepatic Malignancy ..................................................... 70 Pancreatic Cancer ....................................................... 70 Gallbladder Carcinoma .................................................. 73 Hodgkin's Lymphoma ........................................... '.' ...... 73 Complications .......................................................... 74

CHAPTER 8 laparoscopic Inguinal Hernia Repair Robert L. Soares, Jr., and Joseph F. Amaral

Historical Aspects of Inguinal Hernia Repair. .............................. 77 Laparoscopic Hernia Repair .............................................. 78 Controversies ........................................................... 83

CHAPTER 9 laparoscopic Surgery of the Spleen, Adrenal, and Pancreas D.E.M. Litwin, John J. Kelly, and Mark P. Callery

Management of the Spleen .............................................. 87 Management of the Adrenals ............................................ 91 Management of the Pancreas ............................................ 93

CHAPTER 10 laparoscopy for Acute and Chronic Abdominal Pain Mary E. Klingensmith and David C. Brooks

General Technique ...................................................... 99 The Acute Abdomen ................................................... 100 Chronic Abdominal Pain ............................................... 102

CHAPTER 11 Gastric Surgery and Bariatric Procedures Frank H. Chae, Robert C. Mcintyre, Jr., and Gregory V. Stiegmann

Peptic Ulcer Disease .................................................... 105 Gastric Neoplasm ...................................................... 108 Gastrostomy ........................................................... 109 Bariatric Surgery ....................................................... 110

CHAPTER 12 Endoscopic Parathyroid and Thyroid Surgery L. Michael Brunt

Background ............................................................ 117 Experimental Development ............................................. 118 Clinical Application .................................................... 120

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CHAPTER 13 Minimally Invasive Vascular Surgery Takao Ohki and FrankJ. Veith

Required Equipment and Operating Room Set-up ........................ 125 Techniques to Obtain Vascular Access ................................... 126 Endovascular Repair of Aortoiliac Occlusive Disease ...................... 127 Endovascular Repair of Abdominal Aortic Aneurysms .................... 128 Endovascular Repair of Iliac Aneurysms .................................. 132 Discussion ............................................................. 133

CHAPTER 14 Minimally Invasive Techniques in Pediatric Surgery Steven}. Fishman

General Considerations ................................................. 137 Procedures ............................................................ 137 Specific Pediatric Concerns ............................................. 139

CHAPTER 15 Thoracoscopy and Video-assisted Thoracic Surgery Michael T. Jaklitsch Raja M. Flores, and Malcolm M. DeCamp, JT.

General Principles ...................................................... 145 Lung Disease ........................................................... 147 Pericardial and Pleural Effusions ......................................... 151 Mediastinal Diseases ................................................... 152 Esophageal Disease ..................................................... 153 Diaphragm ............................................................ 155 Expanding Indications .................................................. 156

CHAPTER 16 laparoscopy for Urologic Conditions Kevin R. Loughlin and Michael P. O'Leary

Laparoscopic Varicocelectomy .......................................... 159 Laparoscopic Pelvic Lymphadenectomy .................................. 160 Laparoscopic Nephrectomy ............................................. 161 Laparoscopic Pediatric Urology ......................................... 163 Laparoscopic Retroperitoneal Node Dissection ........................... 163 Laparoscopic Management of Lymphoceles .............................. 163 Laparoscopic Ureterolysis ............................................... 164 Laparoscopic Ureteral Reimplant ........................................ 165 Laparoscopic Diverticulectomy ......................................... 165 Laparoscopic Cystectomy ............................................... 165 Laparoscopic Ileal Conduit .............................................. 165 Laparoscopic Bladder Neck Suspension .................................. 165 Retroperitoneal Approach to Urologic Disease ........................... 165 Gasless Technique ...................................................... 165 Laparoscopic Adrenalectomy ........................................... 166

CHAPTER 17 Physiologic Changes Occurring During laparoscopy, Including Port Site Implantation Mark A. Talamini and Michael F. Kutka

History ................................................................ 169 Observed Physiologic Changes .......................................... 169 Extraperitoneallnsufflation ............................................. 172 Selection of Insufflation Gas ............................................ 172 Port Site Implantation .................................................. 172 Detrimental Effects of Laparoscopy ...................................... 173 Laparoscopic Surgery in Pregnancy ...................................... 174 Benefits ofLaparoscopy ................................................ 174

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CHAPTER 18 Suturing and Tissue Approximation Shawn M. Garber and Jonathan M. Sackier

Training ............................................................... 179 Prerequisites of Endoscopic Hand Suturing ............................... 180 Instrumentation ....................................................... 180 The Future of Laparoscopic Suturing and Tissue Approximation ........... 186

CHAPTER 19 Gasless Laparoscopy Albert K. Chin, Edmund K.M. Tsoi, and Claude H. Organ, Jr. The Development of Gasless Laparoscopy ............................... 189 Instruments Used in Gasless Laparoscopy ................................ 190 Rationale for Gasless Laparoscopy .................... '" ................ 192 General Technique ..................................................... 192 Gynecologic Applications ............................................... 195 Extraperitoneal Gasless Endoscopy ...................................... 196 Preperitoneal Procedures ............................................... 196 Retroperitoneal Procedures ............................................. 197 Future Developments in Gasless Laparoscopy .............. " ............ 198

CHAPTER 20 Virtual Reality for Image~guided Surgery Ferenc A. Jolesz, Ron Kikinis, William M. Wells III, William E. Lorensen, and Joachim Kettenbach

Disease Diagnosis ...................................................... 201 Treatment Monitoring .................................................. 201 Multimodality Information Integration .................................. 201 Augmented Intraoperative Visualization ................................. 201 Instrument Tracking .................................................... 202 Intraoperative Guidance ................................................ 202 Computer-based Image Guidance ....................................... 203 Surgical Planning and Simulation ........................................ 203 Intraoperative Image Guidance Using Preoperative Images ................ 203 Intraoperative Image Guidance Using Magnetic Resonance Imaging ....... 205 Monitoring and Control of Magnetic Resonance-guided Ablation

Therapy with Interventional Magnetic Resonance Imaging .............. 207 Intraoperative Magnetic Resonance Imaging for Open Surgeries ........... 207 Virtual Endoscopy ...................................................... 208

CHAPTER 21 Medicolegal Perspectives on Laparoscopic Surgery Kenneth A. Kern

Overview of Laparoscopic Litigation ..................................... 212 Laparoscopic Technology and Medical Liability ........................... 215

INDEX ................................................................ 219

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