Pub Date : 2018-09-19DOI: 10.5772/INTECHOPEN.76466
A. Kohut, L. Goldberg, A. B. D. Meritens
The da Vinci Surgical System is an innovative technology that has advanced the lapa- roscopic treatment of benign and malignant diseases in gynecology. In this chapter, we will discuss the da Vinci Surgical System technology, including its history, utilization, surgical technique for benign and oncologic hysterectomy, future directions and surgical complications. Through a review of the literature, we aim to chronicle the current trends of application in both benign and oncologic gynecologic conditions and describe the current standards of care in this innovative and evolving operative technology. Although the future utility of robotic surgeries and robotic hysterectomies necessitates further research, the potential application of this surgical method affords great promise.
{"title":"Robotic Hysterectomy for Cancer and Benign Pathology","authors":"A. Kohut, L. Goldberg, A. B. D. Meritens","doi":"10.5772/INTECHOPEN.76466","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.76466","url":null,"abstract":"The da Vinci Surgical System is an innovative technology that has advanced the lapa- roscopic treatment of benign and malignant diseases in gynecology. In this chapter, we will discuss the da Vinci Surgical System technology, including its history, utilization, surgical technique for benign and oncologic hysterectomy, future directions and surgical complications. Through a review of the literature, we aim to chronicle the current trends of application in both benign and oncologic gynecologic conditions and describe the current standards of care in this innovative and evolving operative technology. Although the future utility of robotic surgeries and robotic hysterectomies necessitates further research, the potential application of this surgical method affords great promise.","PeriodicalId":397979,"journal":{"name":"New Horizons in Laparoscopic Surgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129835023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-19DOI: 10.5772/INTECHOPEN.76467
T. Nishida, H. Ikuta
Background : While using an irrigation-suction instrument for laparoscopic surgery, the irregular adsorption of fatty tissue may damage the tissue or obstruct continuous sucking. New devices of divided silicone drain tip and Count-on Q ™ to prevent irregular adsorption of fatty tissue were reported. Materials and methods: A cigarette-type silicone drain was cut 4 cm in length, slipped over the instrument to cover the side holes, leaving 1.2 cm free from the end and fixed by means of 1-0 silk above the side holes. The free tip was divided vertically into four even pieces like octopus arms. Count-on Q ™ was the irrigation-suction instrument equipped with multiple small side holes. Results: Divided silicon drain tip could prevent the irregular adsorption of fatty tissue (greater and lesser omentum or epiploic appendices) and could suck saline, fresh, and coagulated blood continuously. Count-on Q ™ also could prevent the irregular adsorption of fatty tissue and could suck saline and fresh blood except coagulated blood continuously. Conclusions : This simple, easy, and inexpensive device of divided silicon drain tip facili- tated the prevention of irregular adsorption of fatty tissue while using a usual irrigation-suction instrument. Count-on Q ™ was the masterpiece of irrigation-suction instrument, preventing irregular adsorption of fatty tissue by itself.
{"title":"How to Prevent Irregular Adsorption of Fatty Tissue into the Irrigation-Suction Instrument","authors":"T. Nishida, H. Ikuta","doi":"10.5772/INTECHOPEN.76467","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.76467","url":null,"abstract":"Background : While using an irrigation-suction instrument for laparoscopic surgery, the irregular adsorption of fatty tissue may damage the tissue or obstruct continuous sucking. New devices of divided silicone drain tip and Count-on Q ™ to prevent irregular adsorption of fatty tissue were reported. Materials and methods: A cigarette-type silicone drain was cut 4 cm in length, slipped over the instrument to cover the side holes, leaving 1.2 cm free from the end and fixed by means of 1-0 silk above the side holes. The free tip was divided vertically into four even pieces like octopus arms. Count-on Q ™ was the irrigation-suction instrument equipped with multiple small side holes. Results: Divided silicon drain tip could prevent the irregular adsorption of fatty tissue (greater and lesser omentum or epiploic appendices) and could suck saline, fresh, and coagulated blood continuously. Count-on Q ™ also could prevent the irregular adsorption of fatty tissue and could suck saline and fresh blood except coagulated blood continuously. Conclusions : This simple, easy, and inexpensive device of divided silicon drain tip facili- tated the prevention of irregular adsorption of fatty tissue while using a usual irrigation-suction instrument. Count-on Q ™ was the masterpiece of irrigation-suction instrument, preventing irregular adsorption of fatty tissue by itself.","PeriodicalId":397979,"journal":{"name":"New Horizons in Laparoscopic Surgery","volume":"515 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132862997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-19DOI: 10.5772/INTECHOPEN.75652
Nidhi Sharma, Vanusha Selvin
The applications of minimally invasive pelvic surgery continue to grow. This chapter focuses primarily on the preoperative evaluation, surgical technique and post-operative care of total laparoscopic hysterectomy. Since laparoscopic assisted vaginal hysterectomy is a slight modification of the procedure it is not being discussed separately. The major physiologic obstacles to safe laparoscopy include pregnancy, increased intra cranial pressure, abnormalities of cardiac output and gaseous exchange in the lung, chronic liver diseases and coagulation disorders. In a redo surgery there may be problems of laparoscopic port entry.
{"title":"Total Laparoscopic Hysterectomy","authors":"Nidhi Sharma, Vanusha Selvin","doi":"10.5772/INTECHOPEN.75652","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.75652","url":null,"abstract":"The applications of minimally invasive pelvic surgery continue to grow. This chapter focuses primarily on the preoperative evaluation, surgical technique and post-operative care of total laparoscopic hysterectomy. Since laparoscopic assisted vaginal hysterectomy is a slight modification of the procedure it is not being discussed separately. The major physiologic obstacles to safe laparoscopy include pregnancy, increased intra cranial pressure, abnormalities of cardiac output and gaseous exchange in the lung, chronic liver diseases and coagulation disorders. In a redo surgery there may be problems of laparoscopic port entry.","PeriodicalId":397979,"journal":{"name":"New Horizons in Laparoscopic Surgery","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127674293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-19DOI: 10.5772/INTECHOPEN.75653
P. Medina, Guido Luis Busnelli, Walter S. Nardi
Diastasis of the rectus is defined as the separation of the midline or alba line, which originates in a laxity of the interlocking fibers from the aponeurosis of both rectus muscles. At present, its surgical correction continues to be discussed. However, there is a multiplicity of factors that justify it.
{"title":"Diastasis Recti and Other Midline Defects: Totally Subcutaneous Endoscopic Approach","authors":"P. Medina, Guido Luis Busnelli, Walter S. Nardi","doi":"10.5772/INTECHOPEN.75653","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.75653","url":null,"abstract":"Diastasis of the rectus is defined as the separation of the midline or alba line, which originates in a laxity of the interlocking fibers from the aponeurosis of both rectus muscles. At present, its surgical correction continues to be discussed. However, there is a multiplicity of factors that justify it.","PeriodicalId":397979,"journal":{"name":"New Horizons in Laparoscopic Surgery","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127859257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-19DOI: 10.5772/INTECHOPEN.74117
F. Sánchez-Margallo, J. A. Sánchez-Margallo, A. Szold
Despite the well-known benefits of minimally invasive surgery (MIS) to the patients, this surgical technique implies some technical challenges for surgeons. These technical limitations are increased with the introduction of laparoendoscopic single-site (LESS) surgery. In order to overcome some of these technical difficulties, new handheld devices have been developed, providing improved functionalities along with precision-driven and articulat- ing instrument tips. In this chapter, we will review the current status of handheld devices for laparoscopy and LESS surgery. Devices that provide additional and innovative func- tionalities in comparison with conventional surgical instruments will be considered. Results will be based on studies published in the scientific literature and our experience. These surgical devices will be organized into two main groups, mechanical devices and robotic-driven devices. In general, these instruments intend to simulate the dexterity of movements of a human wrist. Mechanical devices are cheaper and easier to develop, so most of the available handheld instruments fall into this category. The majority of the robotic-driven devices are needle holders with an articulating tip, controlled by an interface implemented on the instrument handle. In general, these handheld devices claim to offer an enhancement of dexterity, precision, and ergonomics. Results showed that, although both instruments offer similar technical performance, the robotic-driven instrument results in better ergonomics for the surgeon ’ s hand posture during intracorporeal suturing. Besides, we recently conducted a study in which five experienced laparoscopic surgeons performed an urethrovesical anastomosis in a porcine model using the DEX ™ system (unpublished study) ( Figure 3 ). Participants used both a conventional axial-handled laparoscopic needle holder and the robotic instrument. Execution time, surgeon ’ s posture, and pressure exerted by the surgeon ’ s hand were assessed. Results revealed that the DEX ™ system led to better ergonomics for the surgeon ’ s hand, without differences in muscle fatigue between instruments. The robotic device required applying less pressure on the handle by the surgeons during surgery. similar surgical performance. Studies showed that handheld articulating devices facilitate intracorporeal suturing with similar surgery time and outcomes to conventional laparoscopy. Many of the presented handheld instruments are still in early stages of development. Additional efforts should be done in order to improve their functionalities and make them more intuitive. Besides, further innovative solutions should be explored in order to exploit the full potential of LESS surgery. The introduction of novel handheld devices in MIS should be accompanied by a comprehensive training period in order to reach the appropriate level of surgical proficiency.
{"title":"Handheld Devices for Laparoscopic Surgery","authors":"F. Sánchez-Margallo, J. A. Sánchez-Margallo, A. Szold","doi":"10.5772/INTECHOPEN.74117","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.74117","url":null,"abstract":"Despite the well-known benefits of minimally invasive surgery (MIS) to the patients, this surgical technique implies some technical challenges for surgeons. These technical limitations are increased with the introduction of laparoendoscopic single-site (LESS) surgery. In order to overcome some of these technical difficulties, new handheld devices have been developed, providing improved functionalities along with precision-driven and articulat- ing instrument tips. In this chapter, we will review the current status of handheld devices for laparoscopy and LESS surgery. Devices that provide additional and innovative func- tionalities in comparison with conventional surgical instruments will be considered. Results will be based on studies published in the scientific literature and our experience. These surgical devices will be organized into two main groups, mechanical devices and robotic-driven devices. In general, these instruments intend to simulate the dexterity of movements of a human wrist. Mechanical devices are cheaper and easier to develop, so most of the available handheld instruments fall into this category. The majority of the robotic-driven devices are needle holders with an articulating tip, controlled by an interface implemented on the instrument handle. In general, these handheld devices claim to offer an enhancement of dexterity, precision, and ergonomics. Results showed that, although both instruments offer similar technical performance, the robotic-driven instrument results in better ergonomics for the surgeon ’ s hand posture during intracorporeal suturing. Besides, we recently conducted a study in which five experienced laparoscopic surgeons performed an urethrovesical anastomosis in a porcine model using the DEX ™ system (unpublished study) ( Figure 3 ). Participants used both a conventional axial-handled laparoscopic needle holder and the robotic instrument. Execution time, surgeon ’ s posture, and pressure exerted by the surgeon ’ s hand were assessed. Results revealed that the DEX ™ system led to better ergonomics for the surgeon ’ s hand, without differences in muscle fatigue between instruments. The robotic device required applying less pressure on the handle by the surgeons during surgery. similar surgical performance. Studies showed that handheld articulating devices facilitate intracorporeal suturing with similar surgery time and outcomes to conventional laparoscopy. Many of the presented handheld instruments are still in early stages of development. Additional efforts should be done in order to improve their functionalities and make them more intuitive. Besides, further innovative solutions should be explored in order to exploit the full potential of LESS surgery. The introduction of novel handheld devices in MIS should be accompanied by a comprehensive training period in order to reach the appropriate level of surgical proficiency.","PeriodicalId":397979,"journal":{"name":"New Horizons in Laparoscopic Surgery","volume":"93 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116949113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-20DOI: 10.5772/INTECHOPEN.72852
Talha Sarigoz, I. Sarici, Ozgul Duzgun, Mustafa UygarKalayci
In patients with gastric cancer, surgical resection is the only treatment that can offer cure or increase long-term survival. With the accumulation of experience in laparoscopic radical gastrectomy and the progress in surgical instruments, laparoscopic surgery for gastric cancer has gained popularity despite initial concerns regarding safety and oncological adequacy. As a result, laparoscopic technique has been widely applied in gastric cancer. Different meta-analyses showed that laparoscopic procedures are associated with less blood loss but longer operation time. Many studies have reported outcomes of laparoscopic surgery for early gastric cancer, but several authors also have shown that a laparoscopic approach can also be used in cases of advanced gastric cancer. We therefore conducted this study to expand our experience and to evaluate laparoscopic gastrectomy step by step in the light of recent reports while defining key points and surgical technique.
{"title":"Laparoscopic Surgery for Gastric Cancer","authors":"Talha Sarigoz, I. Sarici, Ozgul Duzgun, Mustafa UygarKalayci","doi":"10.5772/INTECHOPEN.72852","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.72852","url":null,"abstract":"In patients with gastric cancer, surgical resection is the only treatment that can offer cure or increase long-term survival. With the accumulation of experience in laparoscopic radical gastrectomy and the progress in surgical instruments, laparoscopic surgery for gastric cancer has gained popularity despite initial concerns regarding safety and oncological adequacy. As a result, laparoscopic technique has been widely applied in gastric cancer. Different meta-analyses showed that laparoscopic procedures are associated with less blood loss but longer operation time. Many studies have reported outcomes of laparoscopic surgery for early gastric cancer, but several authors also have shown that a laparoscopic approach can also be used in cases of advanced gastric cancer. We therefore conducted this study to expand our experience and to evaluate laparoscopic gastrectomy step by step in the light of recent reports while defining key points and surgical technique.","PeriodicalId":397979,"journal":{"name":"New Horizons in Laparoscopic Surgery","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134086909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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