UPDATED TOPICS IN MINIMALLY INVASIVE ABDOMINAL SURGERY Edited by Ahmed AbdelRaouf ElGeidie Updated Topics in Minimally Invasive Abdominal Surgery Edited by Ahmed AbdelRaouf ElGeidie Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which permits to copy, distribute, transmit, and adapt the work in any medium, so long as the original work is properly cited. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. 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Used under license from Shutterstock.com First published October, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Updated Topics in Minimally Invasive Abdominal Surgery, Edited by Ahmed AbdelRaouf ElGeidie p. cm. 978-953-307-773-4 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Laparoscopic Biliary-Pancreatic Surgery 1 Part 1 Chapter 1 Transcylindrical Cholecystectomy for the Treatment of Cholelithiasis and Its Complications Cholecystectomy Under Local Anesthesia 3 E. Javier Grau Talens, Julio Horacio Cattáneo, Rafael Giraldo Rubio and Pablo Gustavo Mangione Castro Chapter 2 Laparoscopic Cholecystectomy in High Risk Patients 27 Abdulrahman Saleh Al-Mulhim Chapter 3 Gallbladder Surgery, Choice of Technique: An Overview 37 E. Nilsson, M. Öman, M.M. Haapamäki and C.B. Sandzén Chapter 4 Laparoscopy-Assisted Distal Pancreatectomy 53 Masahiko Hirota, Daisuke Hashimoto, Kazuya Sakata, Hideyuki Kuroki, Youhei Tanaka, Takatoshi Ishiko, Yu Motomura, Shinji Ishikawa, Yoshitaka Kiyota, Tetsumasa Arita, Atsushi Inayoshi and Yasushi Yagi Laparoscopic Liver Surgery 61 Part 2 Chapter 5 Laparoscopic Liver Resection 63 Robert M. Cannon and Joseph F. Buell Chapter 6 Hilar Glissonean Access in Laparoscopic Liver Resection 77 Akihiro Cho Chapter 7 Laparoscopic Liver Surgery 87 Steven A. White, Rajesh Y. Satchidanand and Derek M. Manas Laparoscopic Appendectomy 113 Part 3 Chapter 8 Laparoscopic Appendectomy 115 Konstantinos M. Konstantinidis and Kornilia A. Anastasakou VI Contents Chapter 9 Appendicitis and Appendicectomy 137 Sami M. Shimi Laparoscopic Hernia Repair Surgery 155 Part 4 Chapter 10 Laparoscopic Hernia Repair 157 Eva Deerenberg, Irene Mulder and Johan Lange Chapter 11 Laparoscopic Incisional Hernia Repair 181 Anita Kurmann and Guido Beldi Laparoscopic Solid Organ Surgery 193 Part 5 Chapter 12 Spleen Preserving Surgery and Related Laparoscopic Techniques 195 Lianxin Liu, Dalong Yin and Hongchi Jiang Chapter 13 Laparoscopic Gastropexy for the Treatment of Wandering Spleen With or Without Gastric Volvulus 205 Caroline Francois-Fiquet,Yohann Renard, Claude Avisse, Hugues Ludot, Mohamed Belouadah and Marie-Laurence Poli-merol Miscellaneous Laparoscopic Procedures 223 Part 6 Chapter 14 Laparoscopic Approach to Abdominal Sepsis 225 José Sebastião Santos, Carlos A.M. Donadelli, Rafael Kemp, Alberto Facury Gaspar and Wilson Salgado Jr. Chapter 15 Role of Endoscopy in Laparoscopic Procedures 237 Mohamed O. Othman, Mihir Patel and Timothy Woodward Preface It goes without saying that the introduction of laparoscopy, with its well-known advantages, changed the face of surgery. Big surgeons make big incision is now proved to be incorrect dictum. Now surgeons can work via key holes to reach areas considered to be very difficult to reach in open surgery. No more ugly big wounds, no more adhesions, less pain, rapid recovery …. and many more. For all these benefits, patients ask their surgeons for laparoscopy. However, laparoscopy is not that easy. It requires new skills and talents that differ from those required in open surgery. It is more difficult and needs more experience and training. We tried in this book to present evidence-based up-to-date information in laparoscopic surgery. This book does not cover all minimally invasive abdominal surgery; only included selected topics covering a variety of medical conditions. Each chapter is written by an expert in laparoscopy. The book is geared not only toward surgical residents in-training, but also to expert surgeons who seek for a recent solution of some controversies. I would like to dedicate this book to my wife Reham, my daughter Salma and my son Omar. Undertaking this book steals time from family, and I very much appreciate their support. I believe you will find this book up-to-date and a useful read that could help you in growing your surgical knowledge about laparoscopy for the sake of your patients. Ahmed AbdelRaouf ElGeidie Gastroenterology Surgical Center, Mansoura University, Egypt [...]... located in the epigastrium about 4 cm to the right of the midline and 3 cm from the costal margin Follows the infiltration of the muscular plane and transverse oblique, lateral to the incision site with the intention of blocking the intercostal nerves VII-IX in the lateral costal margin Finally we infiltrate the rectus muscle 18 Updated Topics in Minimally Invasive Abdominal Surgery of abdomen in the... 4 Updated Topics in Minimally Invasive Abdominal Surgery The first truly major surgery on the biliary tract was performed in 1867 in Indiana (USA) John S Bobbs, professor of surgery at the Medical College of Indiana, operates a tumor in the right upper quadrant in a 30 year old woman, at home and under general anesthesia, resulting in the diagnosis of gallbladder hydrops which was evacuated and drained... It is 10 cm long and 3.8 cm 12 Updated Topics in Minimally Invasive Abdominal Surgery in diameter providing a surgical field area of 11.33 cm2, and another which is 10 cm long but 5 cm in diameter providing to surgical field area of 19.62 cm2 These sizes have been based on the distance between the wall and the hepatocystic triangle, measured in open surgery, and the minimally area necessary for the... proceed to vary the angle of the cylinder to direct medially, to put it in the hepatoduodenal ligament, taking as reference the cystic duct stump Once in the position, the bile duct is seen on the lateral border of the ligament once the fat is cleared away with blunt dissection Fig 10 Cholangiography with cylinder in place 20 Updated Topics in Minimally Invasive Abdominal Surgery We must ensure that we... cholecystectomy) and 16% global choledocholithiasis In the presence of previous pancreatitis, stones were found at choledochotomy in 12% of the patients; in the presence of jaundice or a reliable history of jaundice, 35%; in the previous situation more palpable stone in 99%; with bile duct larger than 1 cm diameter, 58%; 8 Updated Topics in Minimally Invasive Abdominal Surgery jaundice and only cystic dilated... can be freed 14 Updated Topics in Minimally Invasive Abdominal Surgery Fig 3 Incision of 3,5 cm in length Fig 4 Cylinder bottom through the methacrylate plug Transcylindrical Cholecystectomy for the Treatment of Cholelithiasis and Its Complications: Cholecystectomy Under Local Anesthesia 15 Before reaching a working position of the cylinder, this is gently moved inside of the abdomen The blunt shape... tolerated; while that in 25 other general anesthesia was used for suspected acute cholecystitis (8 patients), suspected choledocholithiasis (3 patients) and specifically stated preference for the patient in the other cases (14 patients) Local anesthesia was initiated in 222 patients with demographic and anthropometric characteristics in Table 2 22 Updated Topics in Minimally Invasive Abdominal Surgery Patients,... and, above all, pain 3 The acceptance by the patient has been quick, because it was publicized with all of the above advantages The charisma of laparoscopic technology is undeniable, its elegance, too 6 Updated Topics in Minimally Invasive Abdominal Surgery 4 The commercial pressure has been relentless Technological research has been overturned in the design and implementation of increasingly sophisticated... mg/kg/ev and initiation of infusion of remifentanil in doses of 0.05 mcg/kg/min to 0.1 mcg/kg/ min The objective was to obtain a sedation 2-3 on the Ramsay scale and/or a BIS value of 70 to 85 before the application of local anesthesia For anesthesia of the abdominal wall surgical area was used 300-500 mg of mepivacaine 1% was used The infiltration began in the line previously marked for incision, which... exercises an effect of magnifying glass and once introduced into the abdomen allows visualization of the surgical field before unplugging (figure 1) Fig 1 Cylinders used in Transcylindrical cholecystectomy The cylinder commonly used is made of stainless steel, though we occasionally use a cylinder totally made in methacrylate to facilitate intraoperative cholangiography The size of cylinders is always 10.0 . UPDATED TOPICS IN MINIMALLY INVASIVE ABDOMINAL SURGERY Edited by Ahmed AbdelRaouf ElGeidie Updated Topics in Minimally Invasive Abdominal Surgery Edited. Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Updated Topics in Minimally Invasive. is a definitive treatment for symptomatic cholelithiasis with minimal risk to the patient and a high degree of cure of the symptoms. Updated Topics in Minimally Invasive Abdominal Surgery