This is an open access book. Colorectal surgery is one of the most performed procedures in dedicated colorectal and general surgery units worldwide. In the last two decades, the minimally invasive ...laparoscopic approach has become very popular worldwide, attracting great interest among patients (lower risk of infection, less pain, and faster recovery) and demonstrating excellent oncological results. Technology is improving rapidly, offering revolutionary innovations, particularly with the advent of robotic surgery, which offers important advantages over laparoscopy for both surgeons and patients: improved ergonomics, wristed instruments, and a better vision. These advantages may be particularly useful for more complex and challenging situations (complete mesocolic excision, low rectal cancer, one-stage treatment of colorectal and liver metastases, etc.), translating into potential improved surgical and oncological results. Although several books have been published on the subject, the great interest in robotic surgery makes it mandatory, in our opinion, to have a general update in view of the latest technical innovations and the results of the most relevant and recent literature. The book is divided into chapters dealing with the different colorectal segments with their robotic surgical operations and specific technical variants. The new frontiers of benign and emergency colorectal diseases are also considered, as well as the new robotic platforms recently introduced in the healthcare market. Some of them, such as the da Vinci SP single port device, may represent a revolutionary approach for this surgery. Training and cost aspects were also considered.
This is an open access book. The book focuses mainly on the surgical technique, OR setup, equipments and devices necessary in minimally invasive surgery (MIS). It serves as a compendium of ...endolaparoscopic surgical procedures. It is an official publication of the Endoscopic and Laparoscopic Surgeons of Asia (ELSA). The book includes various sections covering basic skills set, devices, equipments, OR setup, procedures by area. Each chapter cover introduction, indications and contraindications, pre-operative patient’s assessment and preparation, OT setup (instrumentation required, patient’s position, etc.), step by step description of surgical procedures, management of complications, post-operative care. It includes original illustrations for better understanding and visualization of specific procedures. The book serves as a practical guide for surgical residents, surgical trainees, surgical fellows, junior surgeons, surgical consultants and anyone interested in MIS. It covers most of the basic and advanced laparoscopic and thoracoscopic surgery procedures meeting the curriculum and examination requirements of the residents.
Computer-assisted techniques in the surgery of the facial skeleton including the skull base are depicted for the very first time in this atlas of navigational surgery. Experienced surgeons as well as ...trainees will benefit from the detailed and well-illustrated information on the use of computer technology in clinical routine, accompanied by the experimental basis of intraoperative accuracy. The authors` inventions in the field of non-invasive registration have led to widespread use of computer-assisted simulation and navigational surgery in this field, so the time is right for a comprehensive publication on the topic. The interdisciplinary approach brings together maxillofacial surgeons, plastic surgeons, ENT surgeons, and neurosurgeons. New methods of non-invasive referencing and the use of virtual models in the field of oral and cranio-maxillofacial surgery are demonstrated. Clinical cases illustrate the practical use of this new technique.
Purpose Three-dimensional (3D) analysis and planning are powerful tools in craniofacial and reconstructive surgery. The elements include 1) analysis, 2) planning, 3) virtual surgery, 4) 3D printouts ...of guides or implants, and 5) verification of actual to planned results. The purpose of this article is to review different applications of 3D planning in craniomaxillofacial surgery. Materials and Methods Case examples involving 3D analysis and planning were reviewed. Common threads pertaining to all types of reconstruction are highlighted and contrasted with unique aspects specific to new applications in craniomaxillofacial surgery. Results Six examples of 3D planning are described: 1) cranial reconstruction, 2) craniosynostosis, 3) midface advancement, 4) mandibular distraction, 5) mandibular reconstruction, and 6) orthognathic surgery. Conclusions Planning in craniomaxillofacial surgery is useful and has applicability across different procedures and reconstructions. Three-dimensional planning and virtual surgery enhance efficiency, accuracy, creativity, and reproducibility in craniomaxillofacial surgery.
The traditional boundaries of the transsphenoidal approach may be expanded to include the region from the cribriform plate of the anterior cranial base to the inferior clivus in the anteroposterior ...plane, and laterally to expose the cavernous cranial nerves and the optic canal. We review our combined experience with these variations on the transsphenoidal approach to various lesions of the sellar and parasellar region.
From 1982 to 2003, we used the extended and parasellar transsphenoidal approaches in 105 patients presenting with a variety of lesions of the parasellar region. This study specifically reviews the breadth of pathological lesions operated and the complications associated with the approaches.
Variations of the standard transsphenoidal approach have been used in the following series: 30 cases of pituitary adenomas extending laterally to involve the cavernous sinus, 27 craniopharyngiomas, 11 tuberculum/diaphragma sellae meningiomas, 10 sphenoid sinus mucoceles, 18 clivus chordomas, 4 cases of carcinoma of the sphenoid sinus, 2 cases of breast carcinoma metastatic to the sella, and 3 cases of monostotic fibrous dysplasia involving the clivus. There was no mortality in the series. Permanent neurological complications included one case of monocular blindness, one case of permanent diabetes insipidus, and two permanent cavernous cranial neuropathies. There were four cases of internal carotid artery hemorrhage, one of which required ligation of the cervical internal carotid artery and resulted in hemiparesis. The incidence of postoperative cerebrospinal fluid fistulae was 6% (6 of 105 cases).
These modifications of the standard transsphenoidal approach are useful for lesions within the boundaries noted above, they offer excellent alternatives to transcranial approaches for these lesions, and they avoid prolonged exposure time and brain retraction. Technical details are discussed and illustrative cases presented.
We present an overview of the history, development, technological advancements, current application, and future trends of cranial endoscopy. Neuroendoscopy provides a safe and effective management ...modality for the treatment of a variety of intracranial disorders, either tumoral or non-tumoral, congenital, developmental, and degenerative, and its knowledge, indications, and limits are fundamental for the armamentarium of the modern neurosurgeon.
Background
Damage control surgery is a management sequence initiated to reduce the risk of death in severely injured patients presenting with physiological derangement. Damage control principles have ...emerged as an approach in non‐trauma abdominal emergencies in order to reduce mortality compared with primary definitive surgery.
Methods
A PubMed/MEDLINE literature review was conducted of data available over the past decade (up to August 2013) to gain information on current understanding of damage control surgery for abdominal surgical emergencies. Future directions for research are discussed.
Results
Damage control surgery facilitates a strategy for life‐saving intervention for critically ill patients by abbreviated laparotomy with subsequent reoperation for delayed definitive repair after physiological resuscitation. The six‐phase strategy (including damage control resuscitation in phase 0) is similar to that for severely injured patients, although non‐trauma indications include shock from uncontrolled haemorrhage or sepsis. Minimal evidence exists to validate the benefit of damage control surgery in general surgical abdominal emergencies. The collective published experience over the past decade is limited to 16 studies including a total of 455 (range 3–99) patients, of which the majority are retrospective case series. However, the concept has widespread acceptance by emergency surgeons, and appears a logical extension from pathophysiological principles in trauma to haemorrhage and sepsis. The benefits of this strategy depend on careful patient selection. Damage control surgery has been performed for a wide range of indications, but most frequently for uncontrolled bleeding during elective surgery, haemorrhage from complicated gastroduodenal ulcer disease, generalized peritonitis, acute mesenteric ischaemia and other sources of intra‐abdominal sepsis.
Conclusion
Damage control surgery is employed in a wide range of abdominal emergencies and is an increasingly recognized life‐saving tactic in emergency surgery performed on physiologically deranged patients.
Bail‐out option when patient in extremis
Background
This is the fourth updated Enhanced Recovery After Surgery (ERAS
®
) Society guideline presenting a consensus for optimal perioperative care in colorectal surgery and providing graded ...recommendations for each ERAS item within the ERAS
®
protocol.
Methods
A wide database search on English literature publications was performed. Studies on each item within the protocol were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts and examined, reviewed and graded according to Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.
Results
All recommendations on ERAS
®
protocol items are based on best available evidence; good-quality trials; meta-analyses of good-quality trials; or large cohort studies. The level of evidence for the use of each item is presented accordingly.
Conclusions
The evidence base and recommendation for items within the multimodal perioperative care pathway are presented by the ERAS
®
Society in this comprehensive consensus review.
The authors previously described a graded approach to skull base repair following endonasal microscopic or endoscope-assisted tumor surgery. In this paper they review their experience with skull base ...reconstruction in the endoscopic era.
A retrospective review of a single-institution endonasal endoscopic patient database (April 2010–April 2017) was undertaken. Intraoperative CSF leaks were graded based on size (grade 0 no leak, 1, 2, or 3), and repair technique was documented across grades. The series was divided into 2 epochs based on implementation of a strict perioperative antibiotic protocol and more liberal use of permanent and/or temporary buttresses; repair failure rates and postoperative meningitis rates were assessed for the 2 epochs and compared.
In total, 551 operations were performed in 509 patients for parasellar pathology, including pituitary adenoma (66%), Rathke’s cleft cyst (7%), meningioma (6%), craniopharyngioma (4%), and other (17%). Extended approaches were used in 41% of cases. There were 9 postoperative CSF leaks (1.6%) and 6 cases of meningitis (1.1%). Postoperative leak rates for all 551 operations by grade 0, 1, 2, and 3 were 0%, 1.9%, 3.1%, and 4.8%, respectively. Fat grafts were used in 33%, 84%, 97%, and 100% of grade 0, 1, 2, and 3 leaks, respectively. Pedicled mucosal flaps (78 total) were used in 2.6% of grade 0–2 leaks (combined) and 79.5% of grade 3 leaks (60 nasoseptal and 6 middle turbinate flaps). Nasoseptal flap usage was highest for craniopharyngioma operations (80%) and lowest for pituitary adenoma operations (2%). Two (3%) nasoseptal flaps failed. Contributing factors for the 9 repair failures were BMI ≥ 30 (7/9), lack of buttress (4/9), grade 3 leak (4/9), and postoperative vomiting (4/9). Comparison of the epochs showed that grade 1–3 repair failures decreased from 6/143 (4.1%) to 3/141 (2.1%) and grade 1–3 meningitis rates decreased from 5 (3.5%) to 1 (0.7%) (p = 0.08). Prophylactic lumbar CSF drainage was used in only 4 cases (< 1%), was associated with a higher meningitis rate in grades 1–3 (25% vs 2%), and was discontinued in 2012. Comparison of the 2 epochs showed increase buttress use in the second, with use of a permanent buttress in grade 1 and 3 leaks increasing from 13% to 55% and 32% to 76%, respectively (p < 0.001), and use of autologous septal/keel bone as a permanent buttress in grade 1, 2, and 3 leaks increasing from 15% to 51% (p < 0.001).
A graded approach to skull base repair after endonasal surgery remains valid in the endoscopic era. However, the technique has evolved significantly, with further reduction of postoperative CSF leak rates. These data suggest that buttresses are beneficial for repair of most grade 1 and 2 leaks and all grade 3 leaks. Similarly, pedicled flaps appear advantageous for grade 3 leaks, while CSF diversion may be unnecessary and a risk factor for meningitis. High BMI should prompt an aggressive multilayered repair strategy. Achieving repair failure and meningitis rates lower than 1% is a reasonable goal in endoscopic skull base tumor surgery.
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