E-Book, Englisch, 428 Seiten
Kilic / Ertan / Kose Robotic Surgery
1. Auflage 2013
ISBN: 978-3-11-030657-6
Verlag: De Gruyter
Format: PDF
Kopierschutz: 1 - PDF Watermark
Practical Examples in Gynecology
E-Book, Englisch, 428 Seiten
ISBN: 978-3-11-030657-6
Verlag: De Gruyter
Format: PDF
Kopierschutz: 1 - PDF Watermark
The advent of robotic surgery brought a rise in the proportion of minimally invasive surgery in gynecology. This book provides a practical guide to this innovative field. First it introduces the basics of robotic surgery and then focuses on specific gynecology-related surgeries. Gynecologists currently practicing robotic surgery as well as those who would like to include robotic surgery in their practice will benefit greatly from this book.
Zielgruppe
Gynecologists, General Surgeons, Urologists
Fachgebiete
- Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Urologie, Andrologie, Venerologie
- Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizin, Gesundheitswesen Medizintechnik, Biomedizintechnik, Medizinische Werkstoffe
- Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Gynäkologie, Geburtshilfe
- Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Chirurgie
Weitere Infos & Material
1;Preface
;5
2;Acknowledgements;7
3;Index of authors;9
4;Part I: Basics;29
4.1;1 Robotic gynecologic surgery – introduction;31
4.1.1;1.1 History;31
4.1.2;1.2 Robotics systems;32
4.1.3;1.3 Endoscopic surgery in gynecology;35
4.1.4;1.4 The advantages of robotic surgery;37
4.1.5;1.5 Limitations of robotic surgery;37
4.1.6;1.6 Telemedicine and robotic surgery: future aspects;37
4.1.7;1.7 Final suggestions;38
4.1.8;References;38
4.2;2 Launching a successful robotic program;41
4.2.1;2.1 Introduction;41
4.2.2;2.2 Phases of a successful robotic gynecologic program;41
4.2.2.1;2.2.1 Planning phase;41
4.2.2.2;2.2.2 Implementation phase (learning curve or initial robotic program);46
4.2.2.3;2.2.3 Evolving program;46
4.2.3;2.3 Academic activities;48
4.2.3.1;2.3.1 Education;48
4.2.3.2;2.3.2 Research;49
4.2.4;2.4 Financial analysis;49
4.2.5;2.5 Conclusion;50
4.2.6;References;50
4.3;3 Financial analysis of robotic surgery in gynecology;51
4.3.1;3.1 Introduction;51
4.3.2;3.2 Cost of robotic surgery;51
4.3.3;3.3 Cost effectiveness of robotic surgery vs. laparoscopic and open approaches;52
4.3.4;3.4 Coverage of robotic surgery by health systems;55
4.3.5;3.5 How to use robotics more cost efficiently?;56
4.3.6;3.6 Conclusion;56
4.3.7;References;56
4.4;4 Training and credentialing in robotic gynecologic surgery and legal issues;59
4.4.1;4.1 Introduction;59
4.4.2;4.2 Training and credentialing;59
4.4.2.1;4.2.1 Training;59
4.4.2.2;4.2.2 Credentialing;60
4.4.3;4.3 Legal issues;61
4.4.3.1;4.3.1 Components of medical malpractice;61
4.4.3.2;4.3.2 Insufficient training and credentialing legal issues;61
4.4.3.3;4.3.3 Robotic proctors and legal issues;62
4.4.4;4.4 Conclusion;63
4.4.5;References;63
4.5;5 Patient positioning, trocar placement, and docking for robotic gynecologic procedures;65
4.5.1;5.1 Introduction;65
4.5.2;5.2 Importance of proper patient positioning and trocar placement;65
4.5.3;5.3 Patient positioning;66
4.5.3.1;5.3.1 Principles of patient positioning;66
4.5.4;5.4 Trocar placement;69
4.5.4.1;5.4.1 Peritoneal access;69
4.5.4.2;5.4.2 Trocar placement;69
4.5.5;5.5 Initial survey;73
4.5.6;5.6 Docking;73
4.5.6.1;5.6.1 Docking types;74
4.5.7;5.7 Conclusion;74
4.5.8;References;75
4.6;6 Role of the robotic surgical assistant;77
4.6.1;6.1 The surgeon in the area of conflict between autonomy and dependency;77
4.6.2;6.2 Tasks of the robotic surgical assistant;78
4.6.2.1;6.2.1 Tasks of the robotic surgical assistant previous to the beginning of the surgical intervention;78
4.6.2.2;6.2.2 Tasks of the robotic surgical assistant between beginning of the surgery and start of the console phase;80
4.6.2.3;6.2.3 Tasks of the robotic surgical assistant during the console phase;80
4.6.2.4;6.2.4 Tasks of the robotic surgical assistant after termination of the console phase until the skin closure;83
4.6.3;6.3 Selection criteria of the robotic surgical assistant;83
4.6.4;6.4 Training/education of the robotic surgical assistant;84
4.6.4.1;6.4.1 Practical and virtual simulation/simulator systems;85
4.6.4.2;6.4.2 Training programs – request and reality;86
4.6.5;6.5 Aspects of spatial arrangement and structures of communication;87
4.6.6;6.6 Available data relating to the role of the robotic surgical assistant/existing evidence;90
4.6.7;6.7 Conclusions;91
4.6.8;References;92
4.7;7 Strategies for avoiding complications from robotic gynecologic surgery;95
4.7.1;7.1 Introduction;95
4.7.2;7.2 Patient positioning – prevention of neurologic injuries;96
4.7.3;7.3 Complications of pneumoperitoneum and steep Trendelenburg;98
4.7.4;7.4 Robotic equipment;99
4.7.4.1;7.4.1 Electrosurgical principles;99
4.7.4.2;7.4.2 Monopolar electrosurgery;99
4.7.4.3;7.4.3 Bipolar electrosurgery;101
4.7.5;7.5 Avoiding surgical complications;101
4.7.5.1;7.5.1 Avoiding port complications;102
4.7.5.2;7.5.2 Gastrointestinal complications;103
4.7.6;7.6 Genitourinary complications;104
4.7.6.1;7.6.1 Bladder;104
4.7.6.2;7.6.2 Ureter;105
4.7.7;7.7 Complications of pelvic and para-aortic lymph node dissection;106
4.7.8;7.8 Incisional hernia;107
4.7.9;7.9 Vascular injuries;108
4.7.10;7.10 Vaginal cuff dehiscence;109
4.7.11;7.11 Summary;109
4.7.12;References;110
5;Part II: General gynecology;115
5.1;8 Robotically-assisted simple hysterectomy;117
5.1.1;8.1 Introduction;117
5.1.1.1;8.1.1 Background;117
5.1.1.2;8.1.2 Robotic hysterectomy vs. laparoscopy: surgical outcomes;119
5.1.1.3;8.1.3 Cost analysis;123
5.1.2;8.2 Robot-assisted simple hysterectomy procedure;123
5.1.2.1;8.2.1 Positioning the patient;123
5.1.2.2;8.2.2 Trocar placement;124
5.1.2.3;8.2.3 Docking;125
5.1.2.4;8.2.4 Instrument selection;127
5.1.2.5;8.2.5 Step-by-step approach to simple hysterectomy;127
5.1.2.6;8.2.6 New innovative techniques for robotic hysterectomy: robotic surgery to laparoendoscopic single-site surgery (R-LESS);134
5.1.3;8.3 Comment;135
5.1.4;References;135
5.2;9 Approach to the big uterus for hysterectomy;139
5.2.1;9.1 Introduction;139
5.2.2;9.2 How large is possible?;139
5.2.3;9.3 Technique;140
5.2.4;9.4 Creating the bladder flap;140
5.2.5;9.5 Approach to vessels;141
5.2.6;9.6 Making the colpotomy;141
5.2.7;9.7 Tissue removal;142
5.2.8;References;143
5.3;10 The difficult robotic hysterectomy;145
5.3.1;10.1 Introduction;145
5.3.2;10.2 The scenarios of difficult and complex hysterectomy;145
5.3.3;10.3 Patients selection for robotic hysterectomy;146
5.3.4;10.4 Pre-operative preparation for a difficult hysterectomy;147
5.3.5;10.5 Technical operative factors and considerations;147
5.3.5.1;10.5.1 Anesthesia considerations;147
5.3.5.2;10.5.2 Following induction of anesthesia;148
5.3.5.3;10.5.3 Patient positioning;148
5.3.5.4;10.5.4 Entry;149
5.3.5.5;10.5.5 Uterine manipulation;150
5.3.5.6;10.5.6 Trocar placement;150
5.3.5.7;10.5.7 Docking;152
5.3.5.8;10.5.8 Steps of robotic hysterectomy;152
5.3.6;10.6 General considerations;154
5.3.6.1;10.6.1 Choice of instruments;155
5.3.6.2;10.6.2 How to avoid trocar site hernia?;155
5.3.6.3;10.6.3 How to avoid losing pneumo peritoneum?;156
5.3.6.4;10.6.4 How to avoid vaginal cuff infection/dehiscence?;156
5.3.6.5;10.6.5 Data collection;157
5.3.6.6;10.6.6 Learning curve;157
5.3.6.7;10.6.7 Continuing professional development;157
5.3.7;References;157
5.4;11 Robot-assisted laparoscopic myomectomy (RALM);159
5.4.1;11.1 Principles of surgical therapy of uterine myomas;159
5.4.2;11.2 Patient selection for robot-assisted laparoscopic myomectomy (RALM);162
5.4.3;11.3 Technical and logistic aspects of robot-assisted myomectomies;162
5.4.3.1;11.3.1 Patient positioning;162
5.4.3.2;11.3.2 Equipment;163
5.4.3.3;11.3.3 Selection of robotic instruments (EndoWrist™ instruments);164
5.4.3.4;11.3.4 Uterine manipulation;165
5.4.3.5;11.3.5 Trocar placement;166
5.4.3.6;11.3.6 Operation schedule for RALM;166
5.4.3.7;11.3.7 Camera work (0° vs. 30° endoscope);168
5.4.3.8;11.3.8 Features and characteristics of robot-assisted myomectomy;168
5.4.3.9;11.3.9 Suturing techniques and suture material;169
5.4.3.10;11.3.10 Adhesion prophylaxis;169
5.4.3.11;11.3.11 Intraabdominal asservation/storage of removed myomas;170
5.4.4;11.4 Advantages of robotic assistance concerning myomectomies;170
5.4.5;11.5 Disadvantages and deficiencies of robotic assistance concerning myomectomy;171
5.4.6;11.6 Preoperative preparations/perioperative management;171
5.4.6.1;11.6.1 Indications for robot-assisted myomectomy;171
5.4.6.2;11.6.2 Organ-specific diagnostics;174
5.4.6.3;11.6.3 Medicamentous pretreatment;174
5.4.6.4;11.6.4 Preparation of the surgery;176
5.4.6.5;11.6.5 Patient information and informed consent;177
5.4.7;11.7 Recommendations for further diagnostics and treatment/time interval to pregnancy/mode of delivery;177
5.4.8;11.8 Case studies;178
5.4.9;11.9 Authors data of robot-assisted myomectomy;180
5.4.10;11.10 Available data from robot-assisted myomectomies/ existing evidence;183
5.4.11;11.11 Summary and conclusion;185
5.4.12;References;186
5.5;12 Endometriosis: robotic-assisted laparoscopic surgical approaches;189
5.5.1;12.1 Introduction;189
5.5.2;12.2 Application to endometriosis;189
5.5.3;12.3 Surgical approach;190
5.5.4;12.4 Lysis of adhesions;191
5.5.5;12.5 Peritoneal and tubo-ovarian endometriosis;191
5.5.6;12.6 Intestinal endometriosis;192
5.5.7;12.7 Genitourinary endometriosis;194
5.5.8;12.8 Diaphragmatic and thoracic endometriosis;196
5.5.9;12.9 Hepatic endometriosis;197
5.5.10;12.10 Conclusion;197
5.5.11;References;198
5.6;13 Robotic-assisted tubal reanastomosis;203
5.6.1;13.1 Introduction;203
5.6.2;13.2 Surgical technique;204
5.6.2.1;13.2.1 Positioning of the robotic surgical system;204
5.6.2.2;13.2.2 Robotic-assisted tubal reversal procedure;205
5.6.3;13.3 The surgical outcomes of robotic-assisted tubal reversal;206
5.6.4;References;208
5.7;14 Robotic-assisted abdominal cerclage;209
5.7.1;14.1 Introduction;209
5.7.2;14.2 Operative technique;209
5.7.3;14.3 Outcomes;211
5.7.4;References;212
5.8;15 Single-port robotic surgery;215
5.8.1;15.1 Introduction;215
5.8.2;15.2 Surgical technique;217
5.8.3;15.3 Discussion;219
5.8.4;15.4 Conclusion;221
5.8.5;References;221
6;Part III: Gynecologic onocology;223
6.1;16 Update on robotic surgery in the management of cervical cancer;225
6.1.1;16.1 Introduction;225
6.1.2;16.2 Early-stage disease;225
6.1.2.1;16.2.1 Radical hysterectomy;225
6.1.2.2;16.2.2 Radical trachelectomy;229
6.1.3;16.3 Locally advanced disease;231
6.1.4;16.4 Incidental invasive cervical cancer: robotic-radical parametrectomy;232
6.1.5;16.5 Conclusions;233
6.1.6;References;234
6.2;17 Robotic-infrarenal aortic lymphadenectomy: A step-by-step approach;237
6.2.1;17.1 Introduction;237
6.2.2;17.2 Patient selection;237
6.2.3;17.3 Advantages;239
6.2.4;17.4 Approaches;239
6.2.5;17.5 Transperitoneal techniques;240
6.2.5.1;17.5.1 Midline approach, pelvic trocars, no table rotation;240
6.2.5.2;17.5.2 Midline approach, pelvic trocars, 180° table rotation;240
6.2.5.3;17.5.3 Midline approach, subcostal trocars;242
6.2.5.4;17.5.4 Left lateral approach;244
6.2.6;17.6 Extraperitoneal technique;244
6.2.7;17.7 Conclusion;245
6.2.8;References;245
6.3;18 Robotic-pelvic and aortic lymphadenectomy for gynecologic malignancies – one approach;249
6.3.1;18.1 Introduction;249
6.3.2;18.2 The rationale for lymphadenectomy;249
6.3.3;18.3 The minimally-invasive shift;250
6.3.4;18.4 Operating room set-up and patient preparation;251
6.3.5;18.5 Surgical technique for center-docked robotic-assisted aortic lymphadenectomy;254
6.3.6;18.6 Surgical technique for robotic-assisted pelvic lymphadenectomy;256
6.3.7;18.7 Comparative studies;258
6.3.8;18.8 Managing obese patients with endometrial cancer;258
6.3.9;18.9 Future directions;260
6.3.10;18.10 Conclusions;261
6.3.11;References;261
6.4;19 Robotic-extraperitoneal lymphadenectomy: A step-by-step approach;265
6.4.1;19.1 Introduction;265
6.4.2;19.2 Robotic-assisted retroperitoneal laparoscopic para-aortic lymphadenectomy: Technique;267
6.4.2.1;19.2.1 Informed consent;267
6.4.2.2;19.2.2 Examination under anesthesia and cystoscopy;267
6.4.2.3;19.2.3 Position of patient;268
6.4.2.4;19.2.4 Diagnostic laparoscopy;268
6.4.2.5;19.2.5 Entering the extraperitoneal space with intraperitoneal laparoscopic guidance;269
6.4.2.6;19.2.6 Placement of balloon trocar and the formation of the retroperitoneal space;269
6.4.2.7;19.2.7 Placement of surgical trocars into the retroperitoneal space;269
6.4.2.8;19.2.8 Formation of the surgical plan at the retroperitoneal space;270
6.4.2.9;19.2.9 Left aortic and paracaval nodal dissection;270
6.4.2.10;19.2.10 Marsupialization of the retroperitoneal space;271
6.4.3;19.3 Conclusion;271
6.4.4;References;273
6.5;20 Robotic surgery for ovarian cancer;277
6.5.1;20.1 Introduction;277
6.5.2;20.2 Benefits of minimally-invasive surgery;278
6.5.3;20.3 Low-malignant potential or borderline ovarian tumors;278
6.5.4;20.4 Early-stage invasive ovarian cancer;280
6.5.5;20.5 Advanced stage invasive ovarian cancer;282
6.5.6;20.6 Considerations;282
6.5.7;References;284
6.6;21 Risk-reducing bilateral salpingo-oopherectomy in BRCA mutations career;287
6.6.1;21.1 BRCA1/2 mutations;287
6.6.2;21.2 Risk reducing strategies;287
6.6.3;21.3 Risk reducing salpingo-oopherectomy (RRSO);288
6.6.4;21.4 Time of RRSO;290
6.6.5;21.5 Primary peritoneal carcinoma after RRSO;290
6.6.6;21.6 Occult cancer at the time of RRSO;291
6.6.7;21.7 Health proplems after RRSO;292
6.6.8;21.8 Technique of RRSO;292
6.6.9;21.9 RRSO with/without hysterectomy;292
6.6.10;21.10 Radical fimbriectomy: As a new temporary risk reducing surgery;293
6.6.10.1;21.10.1 Laparoendoscopic single port surgery (LEES) for RRSO;293
6.6.11;21.11 Pathologic examination of tuba;294
6.6.12;21.12 Complication of RRSO;295
6.6.13;21.13 Surveilance;295
6.6.14;21.14 Cost analysis;296
6.6.15;References;296
6.7;22 Robotic surgery for uterine cancer;301
6.7.1;22.1 Epidemiology;301
6.7.2;22.2 Presentation;301
6.7.3;22.3 Surgical treatment;301
6.7.4;22.4 Preoperative evaluation;302
6.7.5;22.5 Surgical staging;302
6.7.6;22.6 Patient positioning;303
6.7.7;22.7 Pneumoperitoneum, port placement, and instruments;303
6.7.8;22.8 Anesthesia concerns;304
6.7.9;22.9 Pelvic lymphadenectomy;305
6.7.10;22.10 Para-aortic lymphadenectomy;307
6.7.11;22.11 Omentectomy;310
6.7.12;22.12 Extrafascial hysterectomy;312
6.7.13;22.13 Closure of the vaginal apex;313
6.7.14;References;313
6.8;23 Compartment-based radical surgery: The TMMR, FMMR and PMMR family in uterine cancer;315
6.8.1;23.1 Introduction;315
6.8.2;23.2 Therapeutic pelvic and periaortic lymphadenectomy (rtLNE);316
6.8.3;23.3 Total mesometrial resection (rTMMR);325
6.8.4;23.4 Fertility preserving mesometrial resection (rFMMR);333
6.8.5;23.5 Peritoneal mesometrial resection (rPMMR);335
6.8.6;Acknowledgements;344
6.8.7;References;344
7;Part IV: Urogynecology;347
7.1;24 Robotic surgery for urogynecologic diseases;349
7.1.1;24.1 Introduction;349
7.1.2;24.2 Robotic-vesicovaginal fistula repair;349
7.1.3;24.3 Robotic ureteral reconstructive surgery;350
7.1.4;24.4 Robot-assisted laparoscopic sacrocolpopexy (RALS);351
7.1.5;References;353
7.2;25 Robotic sacrocolpopexy for the management of uterine and vaginal vault prolapse;355
7.2.1;25.1 Introduction;355
7.2.2;25.2 Evaluation and surgical indications;356
7.2.3;25.3 Technique and concomitant procedure;357
7.2.3.1;25.3.1 Preoperative preparation;357
7.2.3.2;25.3.2 Patient positioning and initial preparation;357
7.2.3.3;25.3.3 Access and port placement;358
7.2.3.4;25.3.4 Surgical technique;360
7.2.3.5;25.3.5 Sacral dissection;361
7.2.3.6;25.3.6 Anterior dissection;363
7.2.3.7;25.3.7 Posterior dissection;364
7.2.3.8;25.3.8 Mesh preparation;365
7.2.3.9;25.3.9 Follow-up;369
7.2.4;25.4 Outcomes and complications;370
7.2.4.1;25.4.1 Anatomical and functional outcomes of RASC;370
7.2.4.2;25.4.2 Complications;373
7.2.4.3;25.4.3 Disadvantages;373
7.2.5;25.5 Conclusion;374
7.2.6;References;374
7.3;26 Robotic-retropubic urethropexy;377
7.3.1;26.1 Introduction;377
7.3.2;26.2 Midurethral sling versus robotic retropubic urethropexy;377
7.3.3;26.3 Evolution of the robotic Burch colposuspension;378
7.3.4;26.4 Step-by-step description of the robotic-assisted Burch colposuspension;379
7.3.4.1;26.4.1 Preoperative planning;379
7.3.4.2;26.4.2 Positioning the patient and Foley insertion;379
7.3.4.3;26.4.3 Docking;379
7.3.4.4;26.4.4 Trocar insertion;380
7.3.4.5;26.4.5 Concomitant procedures;380
7.3.4.6;26.4.6 Repositioning the patient;380
7.3.4.7;26.4.7 Retrograde filling of the bladder;380
7.3.4.8;26.4.8 Dissection to create the retropubic space of Retzius;381
7.3.4.9;26.4.9 Identification of urethro-vesicular junction (UVJ) using hand in the vagina;381
7.3.4.10;26.4.10 Suturing;381
7.3.4.11;26.4.11 Cystoscopy;382
7.3.5;References;384
8;Part V: Specialties;387
8.1;27 Pediatric gynecology for robotic surgery;389
8.1.1;27.1 Introduction;389
8.1.2;27.2 Sling procedure for bladder outlet incompetence;389
8.1.2.1;27.2.1 Surgical technique;390
8.1.3;27.3 Vaginoplasty;393
8.1.3.1;27.3.1 Surgical technique;393
8.1.4;27.4 Hysterectomy;394
8.1.4.1;27.4.1 Surgical technique;395
8.1.5;27.5 Surgical management of endometriosis;395
8.1.5.1;27.5.1 Surgical technique;396
8.1.6;27.6 Conclusion;396
8.1.7;References;396
8.2;28 Robotic-assisted surgery advances benefit patients;399
8.3;29 Gynecology-related general surgery;401
8.3.1;29.1 How do gastrointestinal injuries occur?;401
8.3.2;29.2 Management of the gastrointestinal injuries;401
8.3.2.1;29.2.1 Bowel injuries;401
8.3.2.2;29.2.2 Small bowel injuries;402
8.3.2.3;29.2.3 Large bowel injuries;403
8.3.2.4;29.2.4 Rectal injury;404
8.3.2.5;29.2.5 Stomach Injury;404
8.3.3;29.3 Prevention of gastrointestinal injury;405
8.3.4;References;405
8.4;30 Ophthalmology and steep Trendelenburg;407
8.4.1;30.1 Introduction;407
8.4.2;30.2 Posture-induced ocular changes;407
8.4.3;30.3 Post-operative ophthalmological complications;408
8.4.4;30.4 Ophthalmological patient management;409
8.4.4.1;30.4.1 Preoperative evaluation;409
8.4.4.2;30.4.2 Intraoperative period;410
8.4.4.3;30.4.3 Postoperative assessment;410
8.4.5;30.5 Conclusions;411
8.4.6;30.6 Acknowledgements;411
8.4.7;References;411
8.5;31 The future of telesurgery and new technology;413
8.5.1;31.1 Introduction;413
8.5.2;31.2 Technical description;415
8.5.3;31.3 First preclinical studies;417
8.5.4;References;417
9;Index;419