Minimally Invasive Cancer Management

2. Auflage 2010
ISBN: 978-1-4419-1238-1
Verlag: Springer-Verlag
Format: PDF
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, 380 Seiten

As minimal access approaches to cancer diagnosis, staging, and therapy become more widely used, it is vital for general surgeons, along with laparoscopists, surgical oncologists and medical oncologists, to stay up to date. The editors, a team consisting of a renowned surgical oncologist and a laparoscopic specialist, aim to provide a resource for the practicing general surgeon using basic minimally invasive techniques. The book discusses diagnosis including biopsy with microinstrumentation, staging, and palliative and curative resection. Specific tumor sites are addressed, including esophagus, stomach, spleen, small bowel, pancreato-biliary, hepatic resection, and colo-rectal resection. Minimally invasive approaches to the thoracic and retroperitoneal areas are included. The book provides a thorough overview of basic cancer biology, instrumentation, and ultrasound. Additionally, Greene and Heniford explore controversial issues such as port-site recurrence and the effect of pneumoperitoneum on the spread of cancer cells in the abdomen. Many photographs and line drawings, including 16 in full color, illustrate the principles discussed in the text. A must-have for every practicing general surgeon, laparoscopic fellow, and general surgery resident.

Autoren/Hrsg.

Inhaltsverzeichnis

1;Foreword to the Second Edition;5
2;Foreword to the First Edition;7
3;Preface to the Second Edition;8
4;Preface to the First Edition;9
5;Contents;10
6;Contributors;15
7;Part I Introductory Issues;18
7.1;1 Indications and General Oncologic Principles;19
7.1.1;Oncologic Principles;19
7.1.2;Indications for Diagnostic Laparoscopy;20
7.1.3;Immunologic Consequences of the Surgical Approach;22
7.1.4;Specific Organ Sites;23
7.1.4.1;Pancreatic Malignancy;23
7.1.4.2;Gastric Cancer;24
7.1.4.3;Esophageal Cancer;24
7.1.4.4;Gallbladder Cancer;24
7.1.5;References;25
7.2;2 Cancer Biology Relating to Minimal Access Management;27
7.2.1;Systemic Effects of Minimally Invasive Surgery;28
7.2.2;Effects of Minimally Invasive Surgery on Systemic Cytokines;29
7.2.3;Effects of Minimally Invasive Surgery on Systemic Immunity;30
7.2.3.1;B Cells and Neutrophils;30
7.2.3.2;T Cells;31
7.2.3.3;Monocytes/Macrophages and Dendritic Cells;31
7.2.3.4;Natural Killer Cells;31
7.2.4;Intraperitoneal Oncologic Effects;32
7.2.4.1;Tumor Cell Shedding from the Primary Tumor;32
7.2.4.2;Tumor Cell Dissemination Within the Peritoneal Cavity;33
7.2.4.3;Local Surgical Factors in Port Site Recurrence;34
7.2.4.4;Effect of Pneumoperitoneum on Intraperitoneal Tumor Growth;34
7.2.5;Effect of Pneumoperitoneum on Peritoneal Mesothelial Cells;34
7.2.6;Effect of Pneumoperitoneum on Peritoneal Immune Cells;35
7.2.7;Conclusion;37
7.2.8;References;37
7.3;3 Pneumoperitoneum: Metabolicand Mechanical Effects;44
7.3.1;Historical Concepts;44
7.3.2;Current Concepts;45
7.3.3;Environmental Effects;46
7.3.4;Intravascular Effects;47
7.3.5;Immunologic Alterations;48
7.3.6;Mechanical Effects;48
7.3.7;Conclusion;48
7.3.8;References;49
7.4;4 Energy Sources in Laparoscopy;50
7.4.1;Introduction;50
7.4.2;Electrosurgery;50
7.4.2.1;Electrosurgery Defined;51
7.4.2.2;Applications of Electrosurgery;51
7.4.2.3;Therapeutic Applications of Electrosurgery;52
7.4.2.4;Argon Beam Coagulation;53
7.4.2.5;Complications;53
7.4.2.6;Pacemakers and Electrosurgery;54
7.4.3;Ultrasonic Energy;54
7.4.3.1;Harmonic;54
7.4.3.2;LigaSure;55
7.4.3.3;EnSeal;57
7.4.4;Radiofrequency Energy;57
7.4.5;Conclusion;58
7.4.6;References;58
7.5;5 Biopsy and Staging: Technical Issues;60
7.5.1;Rationale;60
7.5.2;Operating Room Setup;61
7.5.3;Technical Issues;62
7.5.4;Biopsy Techniques Following Standard Staging Laparoscopy;65
7.5.4.1;Peritoneal Lavage for Cytological Analysis;65
7.5.4.2;Fine Needle Aspiration Cytology (FNAC);65
7.5.4.3;Pinch Biopsy/Scrape Biopsy;65
7.5.4.4;Cup Biopsy;65
7.5.4.5;Core Biopsy and Laparoscopic Ultrasound Guidance;66
7.5.4.6;Incisional Biopsy;66
7.5.4.7;Excisional Biopsy;66
7.5.4.8;Lymph Node Biopsy;67
7.5.4.9;Sentinel Node Biopsy;67
7.5.5;References;68
7.6;6 Ultrasound Techniques in Minimally Invasive Oncologic Surgery;69
7.6.1;Introduction;69
7.6.1.1;Basic Equipment and Operating Room Setup for Laparoscopic Ultrasound;70
7.6.1.2;Basic Techniques of Laparoscopic Ultrasound Examination;70
7.6.2;Laparoscopic Ultrasound for Hepatobiliary Neoplasms;71
7.6.2.1;Techniques for Laparoscopic Ultrasound Exam of the Biliary Tree;71
7.6.2.2;Techniques for Laparoscopic Ultrasound Exam of the Liver;72
7.6.2.3;Specific Applications and Results of Laparoscopic Ultrasound for Hepatobiliary Tumors;73
7.6.2.3.1;Staging of Primary and Secondary Liver Tumors;73
7.6.2.3.2;Ultrasound Guidance of Liver Biopsy, Ablation, and Resection;74
7.6.3;Techniques for Laparoscopic Ultrasound of the Pancreas;76
7.6.3.1;Specific Applications and Results of Laparoscopic Ultrasound for Pancreatic Neoplasms;77
7.6.3.1.1;Staging of Pancreatic Adenocarcinoma;77
7.6.3.1.2;Localization and Resection of Pancreatic Neuroendocrine Tumors;78
7.6.3.1.3;Evaluation and Resection of Cystic Neoplasms of the Pancreas;78
7.6.4;Laparoscopic Ultrasound for Other Neoplasms;79
7.6.4.1;Techniques for Laparoscopic Ultrasound Examination of Lymph Nodes;79
7.6.4.2;Specific Applications of Laparoscopic Ultrasound to Other Neoplasms;79
7.6.4.2.1;Esophagus and Stomach;79
7.6.4.2.2;Adrenal Gland and Kidney;80
7.6.5;Future of Ultrasound in Minimally Invasive Surgery;80
7.6.6;References;80
8;Part II Management of Foregut Cancer;82
8.1;7 Endoscopic Ablation of Barrett's Esophagus and Early Esophageal Cancer;83
8.1.1;Introduction;83
8.1.2;Risk of Progression to Dysplasia and Esophageal Adenocarcinoma;83
8.1.3;Rationale for Endoscopic Ablation of Barretts Epithelium;84
8.1.4;Ablation Technology and Outcomes;85
8.1.4.1;Circumferential Balloon-Based Radiofrequency Ablation (RFA);85
8.1.4.2;Photodynamic Therapy (PDT);88
8.1.4.3;Cryotherapy;91
8.1.4.4;Endoscopic Resection (ER);92
8.1.5;References;95
8.2;8 Management of Esophageal Cancer;98
8.2.1;Initial Evaluation and Clinical Staging;99
8.2.2;Endoscopic Mucosal Resection;100
8.2.3;Minimally Invasive Esophagectomy;100
8.2.3.1;Laparoscopic Inversion Esophagectomy;101
8.2.3.1.1;Patient Positioning and Port Placement;101
8.2.3.1.2;Hiatal Dissection and Division of the Left Gastric Vessels;101
8.2.3.1.3;Gastric Mobilization;101
8.2.3.1.4;Creation of the Gastric Conduit and Distal Esophageal Mobilization;102
8.2.3.1.5;Cervical Esophageal Exposure;102
8.2.3.1.6;Esophageal Inversion;102
8.2.3.1.7;Esophageal Reconstruction;104
8.2.3.2;Thoracoscopic--Laparoscopic Esophagectomy;104
8.2.3.2.1;Thoracoscopy;104
8.2.3.2.2;Laparoscopy;105
8.2.3.3;Choice of Approach;105
8.2.4;Palliation of Dysphagia;105
8.2.4.1;Esophageal Dilation;106
8.2.4.2;Esophageal Stenting;106
8.2.4.3;Nd:YAG Laser;106
8.2.4.4;Photodynamic Therapy;106
8.2.4.5;Palliative Chemotherapy and Radiation;106
8.2.5;References;106
8.3;9 Laparoscopic Resection of Gastrointestinal Stromal Tumors;109
8.3.1;Preoperative Preparation;110
8.3.2;Local Excision Techniques by Location;111
8.3.2.1;Anterior Gastric Wall;111
8.3.2.2;Posterior Gastric Wall;112
8.3.2.3;Greater and Lesser Curvatures;113
8.3.2.4;Distal Stomach/Pylorus;113
8.3.2.5;Gastroesophageal Junction;113
8.3.3;Gastrectomy;114
8.3.3.1;Partial Gastrectomy;114
8.3.4;Total Gastrectomy;115
8.3.5;Results;116
8.3.6;Discussion;117
8.3.7;Conclusion;119
8.3.8;References;120
8.4;10 Laparoscopic Approaches to Gastric Cancer;122
8.4.1;Introduction;122
8.4.2;Present Status of Laparoscopic Gastrectomy in Japan;123
8.4.3;Indications for LADG in Japan;123
8.4.4;Techniques of LADG with D1+ß Lymph Node Dissection;124
8.4.4.1;Patient Positioning and Port Placement;124
8.4.4.2;Dissection of the Greater Omentum (No. 4d Ln Dissection) and the Left Gastroepiploic Vessels (No. 4sb Ln Dissection);124
8.4.4.3;Dissection of the Right Gastroepiploic Vessels (No. 6 LN Dissection);124
8.4.4.4;Dissection of the Lesser Omentum (No. 3 LN Dissection) and Division of the Right Gastric Vessels (No. 5 LN Dissection);125
8.4.4.5;Transection of the Duodenum;125
8.4.4.6;DissectionofLymphNodesAlongthe Common Hepatic Artery and Celiac Artery (Nos. 8, 9 LN Dissections);126
8.4.4.7;Division of the Left Gastric Vessels (No. 7 LN Dissection);126
8.4.4.8;Dissection of the Left Cardiac and Superior Gastric Lymph Nodes (Nos. 1, 3 LN Dissection);126
8.4.4.9;Mini-Laparotomy and Roux-en-Y Reconstruction;126
8.4.4.10;Irrigation and Drainage;127
8.4.5;Evaluations of LADG for Early Gastric Cancer (EGC);127
8.4.5.1;Technical Feasibility;128
8.4.5.2;Oncologic Feasibility;128
8.4.5.3;Advantages of LADG vs. ODG for EGC;129
8.4.6;Extension of Indications for LADG;129
8.4.6.1;LADG for Obese Patients and Elderly Patients;129
8.4.6.2;LADG for Advanced Cancer;129
8.4.7;Development of Laparoscopic Gastrectomy;130
8.4.7.1;Laparoscopic Total Gastrectomy (LTG) and Proximal Gastrectomy (LPG);130
8.4.7.2;Totally Laparoscopic Distal Gastrectomy;130
8.4.8;Conclusion;130
8.4.9;References;133
9;Part III Management of Hepatopancreaticobiliary Cancer;135
9.1;11 Minimal Access Management of Pancreatic Cancer;136
9.1.1;Laparoscopic Staging of Pancreatic Cancer;137
9.1.1.1;Technique;138
9.1.2;Laparoscopic Distal Pancreatectomy;139
9.1.2.1;Technique;139
9.1.2.2;Pancreatic Leak;140
9.1.2.3;Splenectomy;141
9.1.3;Laparoscopic Pancreaticoduodenectomy;142
9.1.3.1;Technique;142
9.1.4;Laparoscopic Palliation of Pancreatic Adenocarcinoma;144
9.1.4.1;Endoscopic Biliary and Duodenal Stenting;145
9.1.4.1.1;Endoscopic Biliary Stents Versus Surgical Bypass;145
9.1.4.1.2;Endoscopic Duodenal Stenting Versus Surgical Bypass;146
9.1.4.2;Laparoscopic Palliation;146
9.1.4.2.1;Double Bypass;146
9.1.4.2.2;Technique for Minimally Invasive Biliary Bypass;147
9.1.4.2.3;Technique for Minimally Invasive Gastrojejunostomy;147
9.1.4.3;Cholecystojejunostomy Versus Choledochojejunostomy;147
9.1.4.4;Prophylactic Palliation of Duodenal Obstruction;148
9.1.4.5;Splanchnicectomy;148
9.1.5;Conclusion;148
9.1.6;References;148
9.2;12 Laparoscopic Approaches to PancreaticEndocrine Tumors;152
9.2.1;Overview;152
9.2.2;Pathology;152
9.2.3;Epidemiology and Natural History;153
9.2.4;Diagnosis and Treatment;154
9.2.5;Lesions Located in the Head and Uncinate Process;155
9.2.6;Lesions in the Neck, Body, and Tail;156
9.2.7;Techniques;157
9.2.8;Patient Positioning and Setup;157
9.2.9;Hand-Assisted Laparoscopic Techniques;158
9.2.10;Laparoscopic Distal Pancreatectomy and Splenectomy;158
9.2.11;Laparoscopic Distal Pancreatectomy with Spleen Preservation;161
9.2.12;Robotics;162
9.2.13;Conclusion;163
9.2.14;References;163
9.3;13 Laparoscopic Approaches to Hepatobiliary Cancer;165
9.3.1;General Considerations;167
9.3.2;Laparoscopy and Immune Function;168
9.3.3;Laparoscopic Staging and Determination of Resectability;168
9.3.4;Laparoscopic Staging Techniques for Hepatobiliary Cancer;171
9.3.4.1;Minilaparoscopy;172
9.3.4.2;Laparoscopic Ultrasound;172
9.3.4.3;Biopsy Techniques;174
9.3.4.4;Procedure Completion;175
9.3.5;Results;175
9.3.6;Indications for Laparoscopic Surgery in Patients with Hepatobiliary Cancers;176
9.3.7;Indications for Minimally Invasive Palliation;177
9.3.7.1;Regional Chemotherapy;177
9.3.7.2;Debulking;177
9.3.7.3;Biliary Drainage;177
9.3.7.4;Enteric Bypass;178
9.3.7.5;Pain Management;178
9.3.8;Indications for Laparoscopic Curative Surgery;178
9.3.8.1;Liver Cancer;178
9.3.8.2;Gallbladder Cancer;179
9.3.9;Minimally Invasive Surgical Techniques;179
9.3.9.1;Totally Laparoscopic Liver Resection;179
9.3.9.2;Hand-Assisted Laparoscopic Resection;181
9.3.9.3;Laparoscopy-Assisted Open Resection;181
9.3.9.4;Technique for Ablation;182
9.3.10;Hepatic Artery Infusion Pumps;183
9.3.11;Biliary Bypass;184
9.3.12;Cholecystojejunostomy;184
9.3.13;Choledochojejunostomy;184
9.3.14;Segment Three Bypass;185
9.3.15;Enteric Bypass;186
9.3.16;Conclusion;186
9.3.17;References;187
9.4;14 Laparoscopic Approaches to ColonicMalignancy;191
9.4.1;Techniques;191
9.4.2;Resection of the Right Colon;192
9.4.3;Resection of the Left Colon;193
9.4.4;Resection of the Sigmoid Colon;194
9.4.4.1;Results;194
9.4.4.2;Contraindications;195
9.4.4.3;Complications;195
9.4.4.4;Learning Curve;197
9.4.4.5;Conversion;198
9.4.5;Cancer Issues;198
9.4.5.1;Extent of Resection;198
9.4.5.2;Tumor Staging;199
9.4.5.3;Wound Recurrences;200
9.4.5.4;Results of Randomized Trials and Meta-Analyses;200
9.4.5.5;Credentialing;201
9.4.6;Outlook;201
9.4.7;Conclusion;202
9.4.8;References;202
9.5;15 Laparoscopic Resection of Rectal Cancer;205
9.5.1;Current Issues and Concerns;205
9.5.2;Diagnosis and Staging;206
9.5.3;Oncologic Principles and Operative Strategy;206
9.5.4;Indications and Contraindications;207
9.5.5;Preoperative Preparation;207
9.5.6;Perioperative Preparation;207
9.5.7;Instruments;207
9.5.8;Positioning;208
9.5.9;Port Placement;208
9.5.10;Procedure;209
9.5.10.1;Assessment and Tumor Localization;209
9.5.11;Liver Evaluation;209
9.5.11.1;Direct Inspection;209
9.5.12;Overview of Laparoscopic Proctectomy;210
9.5.13;Mobilization of the Left Colon and Splenic Flexure;210
9.5.14;Pelvic Dissection;212
9.5.15;Mesenteric Transection;214
9.5.16;Specimen Exteriorization;215
9.5.17;Anastomosis;216
9.5.18;Creation of Ileostomy;216
9.5.19;Closure;217
9.5.20;Specific Considerations and Problems;217
9.5.20.1;Mesorectal Excision with Autonomic Nerve Preservation;217
9.5.21;Hemorrhage;217
9.5.22;Conversion to Open Procedure;217
9.5.23;Prevention of Port-Site Recurrence;218
9.5.24;Postoperative Care and Complications;218
9.5.25;Contraindications;218
9.5.26;Results;218
9.5.27;Multicenter Prospective Randomized Trial;219
9.5.28;Surgical Education;219
9.5.29;Conclusion;220
9.5.30;References;220
9.6;16 Transanal Endoscopic Microsurgery (TEM);222
9.6.1;Introduction;222
9.6.2;Development;223
9.6.3;Instrumentation;223
9.6.4;Evaluation and Patient Selection;225
9.6.5;Procedure;227
9.6.6;Postoperative Care;230
9.6.7;Results;230
9.6.8;References;231
9.7;17 Laparoscopic Ablation of Liver Tumors;233
9.7.1;Introduction;233
9.7.2;Spectrum of Disease;234
9.7.3;Liver Metastases from Colorectal Cancer;234
9.7.4;Hepatocellular Carcinoma;235
9.7.5;Physics of Thermal Ablation;236
9.7.6;Surgical Technique for Laparoscopic Ablation;237
9.7.7;Outcomes for Ablation;239
9.7.8;Conclusion;241
9.7.9;References;241
10;Part IV Laparoscopic Management of Other Solid Organs;242
10.1;18 Laparoscopic Splenectomy for Malignant Diseases;243
10.1.1;Indications;244
10.1.2;Lymphoproliferative Disease;244
10.1.2.1;Hodgkin's Disease;244
10.1.2.2;Non-Hodgkin's Lymphoma (NHL);245
10.1.2.3;Hairy Cell Leukemia;246
10.1.3;Myeloproliferative Disease;247
10.1.4;Selection Criteria;247
10.1.5;Preoperative Preparation;248
10.1.6;Operative Technique;249
10.1.7;Outcomes;251
10.1.8;Conclusion;253
10.1.9;References;253
10.2;19 Laparoscopic Management of Renal Cell Carcinoma;256
10.2.1;Introduction;256
10.2.2;Laparoscopic Radical Nephrectomy;256
10.2.2.1;Clinical Outcomes and Oncologic Safety;256
10.2.3;Preoperative Evaluation and Imaging;257
10.2.4;Technical Considerations for Laparoscopic Radical Nephrectomy;258
10.2.4.1;Operative Strategy: Hand-Assisted Laparoscopic Radical Nephrectomy;259
10.2.4.1.1;Instrumentation, Patient Positioning, Port Placement, and Procedural Steps;259
10.2.4.1.2;Hand-Assisted Laparoscopic Left Radical Nephrectomy;260
10.2.4.1.3;Hand-Assisted Laparoscopic Right Radical Nephrectomy;263
10.2.4.2;Operative Strategy: Purely Laparoscopic Radical Nephrectomy;264
10.2.5;Laparoscopic Partial Nephrectomy: Indications and Literature Review;264
10.2.6;Preoperative Evaluation and Selection Criteria for Partial Nephrectomy;265
10.2.6.1;Operative Strategy: Hand-Assisted Laparoscopic Partial Nephrectomy (HALPN);266
10.2.6.1.1;Instrumentation, Patient Positioning, Port Placement, and Operative Steps;266
10.2.7;Outcomes for Hand-assisted Partial Nephrectomy;268
10.2.8;Conclusion;269
10.2.9;References;269
10.3;20 Laparoscopic Adrenalectomy for Metastatic Cancer;271
10.3.1;Introduction;271
10.3.1.1;Adrenalectomy for Metastatic Disease: Literature Review and Oncologic Outcomes;271
10.3.1.2;Preoperative Evaluation;273
10.3.2;Operative Technique;274
10.3.2.1;Laparoscopic Trans-abdominal Left Adrenalectomy;274
10.3.2.1.1;Patient Position, Port Strategy, and Establishment of Pneumoperitoneum;274
10.3.2.1.2;Operative Steps;274
10.3.2.2;Laparoscopic Trans-abdominal Right Adrenalectomy;277
10.3.2.2.1;Patient Position and Port Strategy;277
10.3.2.2.2;Operative Steps;278
10.3.2.3;Hand-Assisted Laparoscopic Adrenalectomy;281
10.3.3;Conclusions;282
10.3.4;References;283
10.4;21 Minimally Invasive Approaches to Lung Cancer;284
10.4.1;Background;284
10.4.2;Diagnosis and Staging;285
10.4.2.1;Diagnosis;285
10.4.2.2;Staging;285
10.4.3;Pulmonary Resection;285
10.4.3.1;Sublobar Resection;285
10.4.3.2;Lobectomy;286
10.4.3.2.1;Definition of VATS Lobectomy;286
10.4.3.2.2;Preoperative Evaluation;286
10.4.3.2.3;Techniques;287
10.4.3.2.4;Right Upper Lobectomy;290
10.4.3.2.5;Right Middle Lobectomy;292
10.4.3.2.6;Right Lower Lobectomy;293
10.4.3.2.7;Left Upper Lobectomy;293
10.4.3.2.8;Left Lower Lobectomy;293
10.4.3.2.9;Indications for Open Conversion;293
10.4.4;Palliation;294
10.4.5;Conclusions;294
10.4.6;References;294
10.5;22 Laparoscopy in Gynecologic Malignancies;297
10.5.1;Introduction;297
10.5.2;Surgical Approaches to Gynecologic Disease;298
10.5.3;Restaging;298
10.5.4;Uterine Cancer;299
10.5.5;Ovarian Tumors;301
10.5.5.1;Benign Masses;301
10.5.5.2;Risk of Rupture;302
10.5.5.3;Low Malignant Potential (Atypically Proliferating) Tumors of the Ovary;303
10.5.5.4;Staging in Early Ovarian Cancer;304
10.5.5.5;Advanced Ovarian Cancer;304
10.5.5.6;Second Look Surgery in Ovarian Cancer;305
10.5.5.7;Secondary Resection of Ovarian Cancer;305
10.5.6;Cervical Cancer;305
10.5.6.1;Laparoscopic Sentinel Nodes;306
10.5.6.2;Radical Trachelectomy;307
10.5.6.3;Laparoscopic Radical Parametrectomy;307
10.5.6.4;Pelvic Exenteration;308
10.5.6.5;Fistula Management;308
10.5.7;References;308
11;Part V Special Issues in Cancer Management;313
11.1;23 Minimally Invasive Surgery in Pediatric Oncology;314
11.1.1;Introduction;314
11.1.2;Equipment and Technical Considerations;315
11.1.2.1;Patient Position and Port Placement;315
11.1.2.2;Access;315
11.1.2.3;Insufflation;315
11.1.2.4;Instruments;316
11.1.3;Thoracic Lesions;316
11.1.4;Mediastinal Masses;318
11.1.5;Abdominal and Retroperitoneal Lesions;319
11.1.5.1;Biopsy;319
11.1.5.2;Excision;320
11.1.6;Pelvic Tumors;322
11.1.7;MIS Applications in Treating Morbidities of Chemotherapy;323
11.1.8;Advantages and Disadvantages of Pediatric MIS;324
11.1.9;Conclusion;324
11.1.10;References;325
11.2;24 Endoscopic Diagnosis and Treatment of Breast Diseases;327
11.2.1;Mammary Ductoscopy (MD);328
11.2.1.1;Indications for Mammary Ductoscopy;328
11.2.1.1.1;Pathologic Nipple Discharge (PND);328
11.2.1.1.2;Margin Assessment During Lumpectomy;328
11.2.1.1.3;Intraductal Breast Biopsy;328
11.2.1.1.4;Ductoscopy-Directed Duct Excision;328
11.2.1.2;Ductoscopy Equipment;328
11.2.1.3;Procedure;328
11.2.1.3.1;Patient Analgesia;328
11.2.1.3.2;Nipple Block;328
11.2.1.3.3;Ductoscope Preparation;329
11.2.1.3.4;Identification and Cannulation of the Correct Duct;329
11.2.1.3.5;Irrigation and Visualization;329
11.2.1.3.6;Intraductal Breast Biopsy (IDBB);329
11.2.1.3.7;Ductoscopy-Directed Duct Excision;329
11.2.1.3.8;Cannulating the High-Risk or Cancer Patient;331
11.2.1.3.9;Pathology Considerations;332
11.2.1.4;Limitations;332
11.2.1.5;Advantages;332
11.2.1.6;Pitfalls and Management;332
11.2.1.7;Future Directions;332
11.2.2;Endoscopic Axillary Procedures;332
11.2.2.1;Indications;332
11.2.2.1.1;Sentinel Lymph Node Biopsy;333
11.2.2.1.2;Axillary Lymph Node Dissection;333
11.2.2.2;Equipment;333
11.2.2.3;Procedure;333
11.2.2.3.1;Positioning of the Patient;333
11.2.2.3.2;Establishment of Gas Space in the Axilla;333
11.2.2.3.3;Control of Gas Pressure in Axillary Space;334
11.2.2.3.4;Placement of Trocars;334
11.2.2.4;Procedure for Lymph Node Dissection;334
11.2.2.5;Advantages of Endoscopic Sentinel Lymph Node and Axillary Dissection;335
11.2.2.6;Limitations;335
11.2.2.7;Challenges for Endoscopic Axillary Dissection;335
11.2.3;Endoscopic-Assisted Subcutaneous Mastectomy with Immediate Mammary Prosthesis Reconstruction for Early Breast Cancer;335
11.2.3.1;Indications;335
11.2.3.2;Equipment;335
11.2.3.3;Procedure;335
11.2.3.4;Advantages;336
11.2.3.5;Limitations;336
11.2.4;References;336
11.3;25 The Applications of Sentinel Lymph Node to Cancer;338
11.3.1;Introduction;338
11.3.2;Melanoma;339
11.3.2.1;SLN Mapping Technique;339
11.3.2.2;Surgical Management;339
11.3.2.3;Other Skin Cancers;340
11.3.3;Breast Cancer;341
11.3.3.1;SLN Technique;341
11.3.3.2;Surgical Management;341
11.3.4;Colorectal Cancer;342
11.3.4.1;SLN Technique;342
11.3.4.2;Surgical Management;343
11.3.5;Gastric Cancer;345
11.3.5.1;Sentinel Node Technique;346
11.3.5.2;Surgical Management;346
11.3.6;Esophageal Cancer;347
11.3.6.1;Technique;347
11.3.6.2;Surgical Management;347
11.3.7;Head and Neck Tumors;347
11.3.7.1;Surgical Technique;347
11.3.7.2;Surgical Management;348
11.3.8;Lung Cancer;348
11.3.9;Conclusions;349
11.3.10;References;349
11.4;26 Future Prospects;354
11.4.1;References;356
12;Index;357