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Robotic Complex Abdominal Wall Reconstruction: The Evolution of Component Separation 机器人复杂腹壁重建:组件分离的演变
Pub Date : 2022-02-07 DOI: 10.5772/intechopen.102001
Rodolfo J. Oviedo, Jeffrey Hodges, J. Nguyen-Lee, David Detz, Mary Oh, J. Bombardelli, A. Shah, Atteeba Manzar, A. Martinino
From the first description of the component separation technique in the literature at the end of the twentieth century to the current state of complex abdominal wall reconstruction, this rapidly evolving field of General Surgery has advanced at an accelerated pace. With the advancement of technological breakthroughs that stem from the original open technique, endoscopic, laparoscopic, and more recently robotic approaches have been developed to facilitate complex abdominal wall reconstruction to restore the body’s anatomy and physiology to functional levels. This chapter will give an overview of the historic progression of these advanced techniques and will illustrate the key steps for their safe and effective performance including the endoscopic external oblique anterior release as well as posterior release techniques such as the robotic transversus abdominis release (TAR). Finally, other useful variations of complex repair such as the robotic extended totally extraperitoneal (eTEP) approach will be described.
从20世纪末文献中首次描述组分分离技术到目前复杂腹壁重建的状态,这一迅速发展的普通外科领域正在加速发展。随着原始开放技术的技术突破,内窥镜、腹腔镜和最近的机器人方法已经发展起来,以促进复杂的腹壁重建,使身体的解剖和生理恢复到功能水平。本章将概述这些先进技术的历史进展,并说明其安全有效的关键步骤,包括内窥镜外斜前松解和后松解技术,如机器人腹横松解(TAR)。最后,其他有用的复杂修复的变化,如机器人扩展完全腹膜外(eTEP)方法将被描述。
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引用次数: 0
Spigelian Hernia Spigelian疝
Pub Date : 2022-01-21 DOI: 10.5772/intechopen.102050
Bruno Barbosa, Maria João Diogo, C. Prudente, C. Casimiro
Spigelian hernia (SH) is uncommon and accounts for only 0.12–2% of all abdominal hernias. Spigelian hernia is a protrusion through a defect in the aponeurosis of the transversus abdominis muscle (Spigelian fascia) that is limited by the semilunar line and the lateral edge of the rectus abdominis muscle. It is more common in women 50–60 years and it is twice as common on the right side. Patients may present with non-specific abdominal pain. Clinical diagnosis may be difficult, especially in obese patients, and radiologic exams are essential to obtain the correct diagnoses. This type of hernia has a mandatory indication to surgical repair due to the risk of incarceration that can occur in about 25% and strangulation that can occur in about 40%. Traditionally, open surgical repair is most commonly used. However, laparoscopic approach is becoming increasingly popular since it allows faster recovery, shorter hospital stay, and less pain, with no commitment to recurrence. Currently, there are no studies that demonstrate the superiority of a laparoscopic technique (intraperitoneal onlay mesh (IPOM), transabdominal pre-peritoneal (TAPP) or extraperitoneal approach (TEP)). The intraperitoneal route is a simple, faster, and easily reproducible approach.
Spigelian hernia (SH)并不常见,仅占所有腹疝的0.12-2%。Spigelian疝是腹横肌(Spigelian筋膜)腱膜缺损引起的突出,受半月线和腹直肌外侧边缘的限制。它在50-60岁的女性中更为常见,右侧的发病率是右侧的两倍。患者可能出现非特异性腹痛。临床诊断可能很困难,特别是在肥胖患者中,影像学检查是获得正确诊断的必要条件。这种类型的疝气有手术修复的强制性指征,因为有可能发生嵌顿的风险约为25%,而绞窄的风险约为40%。传统上,开放式手术修复是最常用的。然而,腹腔镜方法正变得越来越流行,因为它允许更快的恢复,更短的住院时间,更少的痛苦,没有复发的承诺。目前,还没有研究证明腹腔镜技术(IPOM)、TAPP或TEP)的优越性。腹腔内途径是一种简单、快速、容易重复的方法。
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引用次数: 0
Laparoscopic Findings of Rare Pediatric Inguinal Hernias 罕见小儿腹股沟疝的腹腔镜检查
Pub Date : 2022-01-20 DOI: 10.5772/intechopen.102028
M. Ohno, Y. Fuchimoto, A. Fujino, Toshihiko Watanabe, Y. Kanamori
Pediatric inguinal hernias are caused to the patency of the processus vaginalis (PPV). The principle for the repair of indirect inguinal hernias in children consists of complete ligation of the PPV. Laparoscopic percutaneous extraperitoneal closure (LPEC) has spread rapidly since it was reported by some groups from around 1998, and the number of institutions adopting this method as a standard procedure for pediatric inguinal hernia is increasing in Japan. Since the closure of PPV by laparoscopic surgery is popular, rare hernias in children can be observed from the abdominal cavity. We present the laparoscopic findings of rare pediatric inguinal hernias and report their experience.
小儿腹股沟疝是由阴道突(PPV)通畅引起的。儿童腹股沟斜疝的修复原则包括完全结扎PPV。腹腔镜下经皮腹膜外缝合术(LPEC)自1998年前后被一些研究小组报道后迅速推广,在日本采用该方法作为小儿腹股沟疝标准手术的机构也在不断增加。由于腹腔镜手术关闭PPV是很普遍的,从腹腔可以观察到罕见的儿童疝。我们报告罕见小儿腹股沟疝的腹腔镜检查结果,并报告他们的经验。
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引用次数: 0
Transabdominal Preperitoneal (TAPP) Inguinal Hernia Repair 经腹腹膜前疝修补术
Pub Date : 2022-01-05 DOI: 10.5772/intechopen.101962
Giovambattista Caruso, G. Evola, Salvatore Antonio Maria Benfatto, Mariapia Gangemi
The inguinal hernia repair is one of the most frequent surgical procedures: in the world, even year, at least 20.000.000 inguinal hernia repair procedures are performed. Although the laparoscopic approach is widely recognized as a valid treatment for many diseases and some laparoscopic surgical procedures have become gold standard techniques (e. g. cholecystectomy, appendectomy, gastro-esophageal junction surgery), the minimally invasive approach for groin hernia treatment is still very controversial today, but in the last few years, it tends to become the standard practice for 1 day surgery. We present here the technique of laparoscopic Transabdominal Preperitoneal approach (TAPP). The surgical technique is described step-by-step, including surgical details and the new concept of “inverted Y” to achieve the “critical view of safety” for laparoscopic inguinal hernia repair.
腹股沟疝修补术是最常见的外科手术之一:在世界范围内,每年至少有2000万例腹股沟疝修补术。尽管腹腔镜入路被广泛认为是许多疾病的有效治疗方法,一些腹腔镜手术已经成为金标准技术(如胆囊切除术、阑尾切除术、胃食管交界手术),但微创入路治疗腹股沟疝在今天仍然存在很大争议,但在最近几年,它倾向于成为1天手术的标准做法。我们在此提出腹腔镜经腹腹膜前入路(TAPP)技术。逐步介绍手术技术,包括手术细节和“倒Y”的新概念,以实现腹腔镜腹股沟疝修补的“安全关键视图”。
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引用次数: 1
Refinements and Advancements in Anterior Component Separation 前体分离的改进与进展
Pub Date : 2019-12-02 DOI: 10.5772/intechopen.90346
S. Kapur, C. Butler
This chapter will explore the newest innovations for performing anterior component separation (CS). It will include open CS, perforator sparing CS and minimally invasive component separation (MICS). It will also address the use of various meshes and their plane of inset. It will cover soft tissue management including panniculectomy, quilting sutures and drains. Fascial closure techniques will also be included. The highlight of this chapter will be the description of tips and tricks of performing MICS. We will also touch upon preoperative preparation such as body mass index (BMI) optimization and smoking cessation as well as management of postoperative complications including surgical site infections, skin necrosis and seroma.
本章将探讨进行前体分离(CS)的最新创新。它将包括开放式CS、保留穿孔器CS和微创组件分离(MICS)。它还将解决各种网格及其插入平面的使用。它将涵盖软组织管理,包括输卵管切除术,缝合和引流。筋膜闭合技术也将包括在内。本章的重点将是描述执行MICS的技巧和技巧。我们还将涉及术前准备,如身体质量指数(BMI)优化和戒烟,以及术后并发症的管理,包括手术部位感染,皮肤坏死和血清肿。
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引用次数: 0
Ventral Hernia: Causes and Management 腹疝:原因和处理
Pub Date : 2019-11-27 DOI: 10.5772/intechopen.88873
A. Rao
Ventral hernia is the most common type of hernia after inguinal hernias. The term “ventral hernia” creates some confusion, because in most countries of the world, especially in Europe, it is considered as incisional hernia, while in the USA, it is usually considered as hernias of anterior abdominal wall except groin hernias. Daily in the world millions of abdominal surgeries are being performed by both open or conventional and laparoscopic techniques, with 3–20% incidence of incisional. That’s why mainly incisional hernia and its causes, risk factors, and predisposing conditions and management will be discussed in this chapter, though other ventral hernias will be described briefly. The important causes, risk factors [congenital and acquired (patients and postoperative)], and predisposing conditions for ventral hernias will be discussed in detail. The signs and symptoms produced by ventral hernia (incision) will be described initially and later, and how to investigate to confirm the diagnosis and necessary investigations before surgery for different types of patients is described. In managing the ventral hernia, different treatment options are discussed and described, like conservative management, open method, laparoscopic technique, and more advanced robotic technique. After surgery postoperative care of patient and wound is also discussed.
腹疝是继腹股沟疝之后最常见的疝类型。“腹侧疝”一词引起了一些混淆,因为在世界上大多数国家,特别是在欧洲,它被认为是切口疝,而在美国,它通常被认为是腹壁前疝,除了腹股沟疝。在世界范围内,每天有数以百万计的腹部手术通过开放或传统和腹腔镜技术进行,切口发生率为3-20%。这就是为什么本章将主要讨论切口疝及其原因、危险因素、易感条件和治疗,而其他腹侧疝将简要描述。腹疝的重要病因、危险因素[先天性和后天性(患者和术后)]、易感条件将被详细讨论。腹疝(切口)产生的体征和症状将在初期和后期进行描述,以及如何调查以确认诊断和针对不同类型的患者进行术前必要的检查。在处理腹疝时,讨论和描述了不同的治疗方案,如保守治疗、开放方法、腹腔镜技术和更先进的机器人技术。并对术后患者及伤口的护理进行了讨论。
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引用次数: 1
Laparoscopic Rare Abdominal Hernia Treatment 腹腔镜治疗罕见腹疝
Pub Date : 2019-11-15 DOI: 10.5772/intechopen.89947
E. Akin, B. Mantoglu, F. Altıntoprak, N. Firat
Diaphragm and abdominal wall hernias are rare, and they may be congenital or acquired. Spiegel hernia incidence is between 0.1 and 2%. Morgagni hernia is comprising only 2–3% of all diaphragmatic hernias. Most Spiegel and Morgagni hernias are diagnosed late because of their non-specific symptoms and asymptomatic clinical presentation. The major symptoms are abdominal pain, vomit-ing, and dyspnea. Computed tomography (CT) shows the hernia sac content, strangulation or incarceration in the content, and detailed anatomical information about surrounding tissue. Surgery is the main treatment option except patients who have severe comorbidity. Spiegel hernia surgery can be performed open or laparoscopic. Intraperitoneal onlay mesh (IPOM), total extraperitoneal procedure (TEP), transabdominal preperitoneal (TAPP) procedure, or partial transabdominal laparoscopic methods are minimal invasive surgery options. In the repair of Morgagni hernia, surgical options may be laparoscopy, laparotomy, thoracotomy, or thoracoscopy.
膈疝和腹壁疝是罕见的,它们可能是先天性的或后天的。明镜疝发生率在0.1% - 2%之间。Morgagni疝仅占所有膈疝的2-3%。大多数Spiegel和Morgagni疝诊断较晚,因为他们的非特异性症状和无症状的临床表现。主要症状是腹痛、呕吐和呼吸困难。计算机断层扫描(CT)显示疝囊内容物,内容物的绞窄或嵌顿,以及周围组织的详细解剖信息。手术是主要的治疗选择,除非患者有严重的合并症。明镜疝手术可以在开放或腹腔镜下进行。腹腔内补片(IPOM)、全腹腔外手术(TEP)、经腹腹膜前手术(TAPP)或部分经腹腹腔镜手术方法是微创手术的选择。在修复Morgagni疝时,手术选择可能是腹腔镜、剖腹、开胸或胸腔镜。
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引用次数: 0
Mesh Fixation Methods in Groin Hernia Surgery 腹股沟疝手术中的补片固定方法
Pub Date : 2019-10-28 DOI: 10.5772/intechopen.89732
M. Burati, A. Scaini, L. Fumagalli, F. Gabrielli, M. Chiarelli
No unanimous consent has been reached by surgeons in terms of a method for mesh fixation in laparoscopic and open surgery for inguinal hernia repair. Many different methods of fixation are available, and the choice of which one to use is still based on surgeons’ preferences. At present, tissue glues, sutures, and laparoscopic tacks are the most common fixating methods. In open technique, sutures have been the method of choice for their reduced costs and surgeons’ habits. Nevertheless, tissue glues have been demonstrated to be effective and safe. Similarly, tacks can be considered the most common means of fixation in laparoscopic hernia repair, but they are connected to a higher risk of complication and morbidity. In this chapter, we present these types of mesh fixation, their characteristics and potential risks, and advantages of their use.
对于腹腔镜和开放手术腹股沟疝修补的补片固定方法,外科医生尚未达成一致意见。有许多不同的固定方法可供选择,使用哪一种仍然取决于外科医生的喜好。目前,组织胶、缝合线和腹腔镜钉是最常见的固定方法。在开放式技术中,由于成本低和外科医生的习惯,缝合一直是首选的方法。然而,组织胶已被证明是有效和安全的。同样,在腹腔镜疝修补术中,钉可以被认为是最常见的固定方式,但它们具有较高的并发症和发病率风险。在本章中,我们介绍了这些类型的网片固定,它们的特点和潜在的风险,以及它们的使用优势。
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引用次数: 3
New Laparoscopic Surgery in Inguinal Hernia Repair 新型腹腔镜手术在腹股沟疝修补中的应用
Pub Date : 2019-09-12 DOI: 10.5772/INTECHOPEN.89028
R. Rudiman, Andika A. Winata
Laparoscopic inguinal herniorrhaphy has become widely accepted as an effective alternative to the treatment of hernias with the anterior approach. It has success rates identical to those of the conventional method and quickens recovery by decreasing time until return to work or physical activities. With the introduction of single incision laparoscopic surgery (SILS), there has been an exponential increase in the number of SILS hernia repair. It probably represents the single most exciting innovation in laparoscopic surgery of the last 2 decades. The main premise of SILS is the use of completely blunt ports, which will negate the risks of bowel and vascular injuries, less wound, less postoperative pain, cosmetically more favorable and lower the recurrent rate.
腹腔镜腹股沟疝修补术已被广泛接受为一种有效的替代治疗疝与前入路。它的成功率与传统方法相同,并且通过缩短恢复工作或体力活动的时间来加速恢复。随着单切口腹腔镜手术(SILS)的引入,SILS疝修补的数量呈指数级增长。它可能是过去二十年来腹腔镜手术中最激动人心的创新。SILS的主要前提是使用完全钝口,这将消除肠和血管损伤的风险,伤口少,术后疼痛少,美观更有利,复发率低。
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引用次数: 1
Rare Presentations of Hernia 罕见的疝气表现
Pub Date : 2019-08-13 DOI: 10.5772/INTECHOPEN.88628
A. Yatawatta
Rare types of hernias require the use of astute clinical judgment and high index of suspicion with supportive information obtained with cross sectional imaging. Having a clear understanding is important to the current surgeon as well as gyne-cologist. This chapter attempts to compile the common types of these rare hernias to discuss anatomical defects, imaging features and treatment options. Technical details of treatment are not offered for each type in detail due to limited scope of this text. The emphasis on clinical examination and judgment cannot be overstated and depending on cross sectional imaging alone for clinical diagnosis is discour-aged. Introduction of minimally invasive surgery has changed the landscape for rare hernias with some new types being added—such as port site hernia—but mostly with less invasive treatment options being added to the armament. It is expected that laparoscopic hernia repair for these rare hernias will be soon the preferred modality of treatment.
罕见类型的疝气需要使用敏锐的临床判断和高怀疑指数与支持信息获得的横断面成像。对于现在的外科医生和妇科医生来说,有一个清晰的认识是很重要的。本章试图整理这些罕见疝的常见类型,讨论解剖缺陷,影像学特征和治疗方案。由于本文的范围有限,没有对每种类型的处理提供详细的技术细节。强调临床检查和判断不能被夸大,仅依靠横断面成像进行临床诊断是不鼓励的。微创手术的引入改变了罕见疝气的治疗现状,增加了一些新类型的疝气,如肝部疝气,但大多数情况下,微创治疗选择被添加到武器中。预计腹腔镜疝修补术将很快成为治疗这些罕见疝的首选方式。
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引用次数: 1
期刊
Hernia Surgery [Working Title]
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