Cleveland Clinic Illustrated Tips and Tricks in Colon and Rectal Surgery

 

Disponibila la comanda in 3-4 saptamani

Filled with the collective wisdom and experience of surgeons at the busiest department of colorectal surgery in the world, Cleveland Clinic Illustrated Tips and Tricks in Colon and Rectal Surgery walks you step by step through each procedure, with pointers given along the way as if from a trusted mentor. You’ll find a unique collection of insight and personal clinical experience in dealing with challenging and unusual situations—tips and techniques you can use when faced with similar circumstances in the operating room.

• Focuses on the performance of surgical techniques, described in bulleted lists and highlighted with more than 600 full-color photographs, drawings, and images.  
• Uses a highly templated format for quick reference: Perioperative Considerations (brief overviews of equipment, anesthesia, patient positioning, and other procedural elements), Technique, and Pearls and Pitfalls, with the vast majority of each chapter devoted to technique.  
• Covers surgery for anorectal disease and pelvic floor disorders, surgery within the abdomen and the pelvis, as well as tips for particular situations such as bowel obstruction, trauma, and the difficult stoma. 
• Designed for general surgery residents, colorectal surgery fellows, and practicing colorectal, general, and oncologic surgeons—those in training or anyone who needs to brush up on the latest techniques. 

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Table of Contents:

Cover

Title Page

Copyright

Dedication

Contributors

Foreword

Preface

Contents

PART I In the Operating Room and Anatomy

Chapter 1 Anatomy of the Colon, Rectum, and Anus

Peritoneum

Small Intestine

Duodenum

Jejunum and Ileum

Jejunum

Ileum

Large Intestine

Cecum and Appendix

Rectum

Anus

2 Tools of the Trade: Retractors, Scopes, Probes, and More

Outpatient Office Equipment

General Equipment (Fig. 2-1)

Office Procedures

Pelvic Floor Evaluation

Operating Room Equipment

Minor Anorectal Procedures

Anoscopy, Proctoscopy, and Transanal Procedures

Retractors

Deep Pelvic Instruments (Fig. 2-19)

Staplers (Fig. 2-20)

3 Principles of Operative Positioning

Perioperative Considerations

SUPINE POSITIONING

Perioperative Considerations

Equipment

Technique

LITHOTOMY POSITION

Perioperative Considerations

Equipment

Technique

LITHOTOMY WITH CANDY CANE STIRRUPS

Perioperative Considerations

Equipment

Technique

LITHOTOMY WITH BOOT-TYPE STIRRUPS (eg, YELLOWFINS)

Perioperative Considerations

Equipment

Technique

LITHOTOMY WITH SPLIT-LEG TABLE

Perioperative Considerations

Equipment

Technique

ARM TUCKING

Perioperative Considerations

Equipment

Technique

CHEST STRAP

Perioperative Considerations

Equipment

Technique

PRONE (ie, KRASKE) POSITIONING

Perioperative Considerations

Equipment

Technique

RECTAL IRRIGATION

Perioperative Considerations

Equipment

Technique

4 Advanced Endoluminal Surgery: Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection

ENDOSCOPIC MUCOSAL RESECTION

Perioperative Considerations

Equipment

Technique

ENDOSCOPIC SUBMUCOSAL DISSECTION

Perioperative Considerations

Equipment

Technique (Fig. 4-6)

Dissection

Postoperative Care

5 Combined Endoscopic and Laparoscopic Surgery

Perioperative Considerations

Equipment

Technique

Postoperative Care

6 Interventional Inflammatory Bowel Disease: Endoscopic Management of Complex Inflammatory Bowel Disease

Endoscopic Balloon Dilation of Strictures

Perioperative Considerations

Equipment

Technique

ENDOSCOPIC STRICTUROTOMY

Perioperative Considerations

Equipment

Technique

ENDOSCOPIC FISTULOTOMY

Perioperative Considerations

Equipment

Technique

ENDOSCOPIC CLOSURE OF SURGICAL LEAK

Perioperative Considerations

Equipment

Technique

ENDOSCOPIC SINUSOTOMY

Perioperative Considerations

Equipment

Technique

7 Office Endoscopy

Perioperative Considerations

Equipment (See Chapter 2)

Technique

Scoping Stomas and Diverted Bowel

Scoping Diverted Bowel

PART II Anorectal Disease

Chapter 8 Hemorrhoidectomy

Perioperative Considerations

Sterile Instruments/Equipment

Surgical Approach

MILLIGAN-MORGAN (OPEN)

Technique

FERGUSON (CLOSED)

Technique

USING AN ENERGY DEVICE

Postprocedural Management

9 Anal Fissures: Lateral Internal Sphincterotomy

Perioperative Considerations

History

Examination

LATERAL INTERNAL SPHINCTEROTOMY

Perioperative Considerations

Sterile Instruments/Equipment

Technique

Postoperative Care

SUMMARY

10 Anoplasty for Anal Stenosis

Perioperative Considerations

Operative Preparation

Patient Positioning

Approach and Equipment

Techniques for Anal Stenosis

FLAP PREPARATION AND SCAR RELEASE

Flap Creation: Basic Steps

Securing the Flap

SPECIFIC FLAP CONFIGURATIONS

Y-V or V-Y Flap

House Flap

Diamond Flap

U Flap

Rotational S Flap

Postoperative Care

11 Anorectal Abscess

Perioperative Considerations

Sterile Instruments/Equipment

Technique

Positioning

Examination under Anesthesia

Specific Considerations in the Management of Anorectal Abscess

Role of Antibiotics

Identification of a Fistula at the Time of Abscess Drainage

PERIANAL AND ISCHIOANAL (ALSO KNOWN AS ISCHIORECTAL) ABSCESS

SUBMUCOSAL ABSCESS

INTERSPHINCTERIC ABSCESS

SUPRALEVATOR ABSCESS

DEEP ANTERIOR OR POSTERIOR ANAL SPACE AND HORSESHOE ABSCESS

Technique

Postoperative Care

12 Complex Anorectal Fistulas

Perioperative Considerations

Sterile Instruments/Equipment

Positioning

Setons

Technique

Draining Seton

Cutting Seton

FISTULOTOMY

Technique

ENDORECTAL ADVANCEMENT FLAP

Perioperative Considerations

Positioning

Technique

Postoperative Care

LIGATION OF INTERSPHINCTERIC FISTULA TRACT

Perioperative Considerations

Positioning

Technique

OTHER PROCEDURES

13 Hidradenitis Suppurativa

Perioperative Considerations

Positioning

Special Equipment

Technique

Excision and flaps

Postoperative Care

14 Rectovaginal Fistula

Perioperative Considerations

Sterile Instruments/Equipment

Positioning

Techniques of Fistula Closure

Advancement Flaps

Semicircular Advancement Flap

Sleeve Advancement Flap

Episioproctotomy

Tissue Interposition

15 Rectourethral Fistulas

Perioperative Considerations

Sterile Equipment

Patient Positioning and Draping (See Chapter 3)

Technique

Initial Dissection

Rectal Closure

Urethral Closure

Posterior Urethroplasty

Gracilis Muscle Interposition

Wound Closure

Postoperative Care

16 Crohn Anorectal Disease

Perioperative Considerations

Sterile Instruments/Equipment

Positioning

Technique Anal Tags (Figure 16-4)

Anal Stenosis (Figure 16-5)

Anal Fissure (Figure 16-6)

Anal Fistula

Perianal Abscess

Hemorrhoidal Disease

17 Pilonidal Disease Excise versus Flap: Technical Tips

Perioperative Considerations

Patient Positioning

Sterile Instruments/Equipment

Indications for Surgical Treatment

Positioning and Preparation

Incision and Drainage

General Technique for All Cases

Lay-Open Technique with Marsupialized Pilonidal Pits and Excision of Pilonidal Pits

Wide Local Excision

Limberg Flap (Rhomboid Flap)

Bascom Flap (Cleft Lift)

Postoperative Care

18 Anal Intraepithelial Neoplasia: Performing High-Resolution Anoscopy

Perioperative Considerations

Preprocedural Interview

Sterile Instruments/Equipment

Technique

DETECTION OF ANAL DYSPLASIA

Anal Colposcopy/High-Resolution Anoscopy

Anal Chromoendoscopy

CHROMOENDOSCOPY WITH RETROFLEXION AND INSUFFLATION

Approach Advantages

Normal Anal Anatomic Landmarks

Examples of Chromoendoscopy with Retroflexion and Insufflation

Postoperative Care

Conclusions

PART III The Abdomen

Chapter 19 Anastomotic Construction Techniques

Perioperative Considerations

General Technical Considerations

Types of Anastomoses Based on Anatomy

ENTEROENTERIC OR ILEOCOLONIC ANASTOMOSES

Perioperative Consideration/Approach

Equipment

Techniques

ILEORECTAL AND COLORECTAL ANASTOMOSES

Perioperative Considerations

Equipment

Techniques

20 Complicated Anastomoses: Turnbull-Cutait

Perioperative Considerations

Preoperative Assessment and Evaluation

Discussion with the Patient

Operative Planning

Positioning

Special Equipment

Technique

Postoperative Care

Between Stages I and II

Following Stage II

21 Left Colectomy

Left Colectomy

Perioperative Consideration

Patient Positioning

Operative Approach

Equipment

Technique

Difficulties in Reach

Postoperative Care

22 Right Colectomy

Perioperative Considerations

Equipment

Anesthesia

Patient Positioning

Approach and Equipment

Technique

Laparoscopic Assessment of Resectability

Isolation of the Ileocolic Pedicle

Mobilization of the Ascending Colon and Hepatic Flexure

Mobilization of the Cecum and Small Bowel Mesentery

Transversus Abdominis Plain Block

Umbilical Incision and Exteriorization of the Right Colon

Standard Extracorporeal Resection and Anastomosis (Also See Chapter 19)

Postoperative Care

23 Approaching the Transverse Colon

Perioperative Consideration

Anesthesia and Patient Positioning

Instruments and Equipment

Technique

Port Placement

Surgical Approaches

Right-Sided Medial-to-Lateral Dissection Approach

Dividing the Transverse Mesocolon from the Right

Left-Sided Medial-to-Lateral Dissection Approach to the Transverse Colon

Mesenteric Approach to the Transverse Colon

Superior Approach to the Transverse Colon

Postoperative Care

24 The Difficult Splenic Flexure

Perioperative Considerations

Patient Positioning

Instruments and Equipment

Technique

25 Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Perioperative Considerations

Intraoperative Assessment

Program Requirements

Developing a Successful Hyperthermic Intraperitoneal Chemotherapy Program

Commonsense Guidelines for Fewer Complications, Frustrations, and Improving Safety

Hyperthermic Intraperitoneal Chemotherapy Perfusion Technique

Surgical Considerations

Management of Bowel Resections

Disease on the Hemidiaphragm

Abdominal Wall and Pelvic Viscera

Placement of Hyperthermic Intraperitoneal Chemotherapy Tubing (Closed Technique)

Intraoperative and Anesthesia Concerns

During Hyperthermic Intraperitoneal Chemotherapy Administration

Summary

Postoperative Management

26 Desmoids

Perioperative Considerations

Genetics

Definitions

Incidence and Risk with Regard to Surgical Planning

Clinical Presentation

Treatment

Patient Positioning

Approach and Equipment

Technique

Technique of Resection

Postoperative Care

27 Enterocutaneous Fistula

Perioperative Considerations

Operative Preparation

Patient Positioning

Approach and Equipment

Technique

Abdominal Closure

Postoperative Care

PART IV The Pelvis

Chapter 28 Intraoperative Radiation Therapy for Colorectal Cancer

Perioperative Considerations

Technique

29 Local Excision of Rectal Neoplasia

Perioperative Considerations

Indications for Surgical Treatment

Limitations

Preoperative Preparation

Patient Positioning

STANDARD TRANSANAL EXCISION

Technique

TRANSANAL MINIMALLY INVASIVE SURGERY

Technique

Postoperative Care

30 Approaching Presacral Tumors

Perioperative Considerations

Preoperative Evaluation

Pathologic Considerations

Multidisciplinary Team Approach

Operative Considerations

Equipment

Technique

POSTERIOR APPROACH

Incision Types

Technique

Posterior Technique of Dissection into the Retrorectal Space

ABDOMINAL APPROACH

COMBINED ABDOMINAL/POSTERIOR APPROACH

Postoperative Care

31 Proctectomy from Above

LAPAROSCOPIC LOW ANTERIOR RESECTION

Perioperative Considerations

Sterile Instruments and Equipment

Patient Positioning

Instrument and Personnel Positioning

Port Insertion

Technique

Left Colon Mobilization

Rectal Mobilization

Postoperative Care

32 Transanal Total Mesorectal Excision

Perioperative Considerations

Preoperative Setting: Rectal Cancer Patients

Anesthesia

Patient Positioning

Prior to Sterile Field Preparation

Sterile Field Preparation and Operating Room Setup

Instruments Needed (See Chapter 31 for the Abdominal Proctectomy Portion)

Purse-String Suture Placement

Important Points to Consider When Performing the Purse-String Suture

PROCTOTOMY

DISSECTION

Connection of Transanal and Abdominal Dissections

Extraction of the Specimen

Anastomosis

Handsewn Anastomosis

Stapled Anastomosis

Distal Purse-String Suture

Postoperative Care

33 GYN-Onc Considerations for Complex and Multivisceral Colorectal Disease

Perioperative Considerations

Background: Gynecologic Organ Involvement by Colon Cancer

Preoperative Considerations

Intraoperative Considerations

Postoperative Care

34 Spinal and Orthopedic Considerations for Advanced Multivisceral Colorectal Cancer

Perioperative Considerations

Indications/Contraindication

Sterile Instruments/Equipment

Surgical Approaches

NAVIGATION/LOCALIZATION FOR OSTEOTOMY

Technique

NERVE ROOT DISSECTION

Technique

OSTEOTOMIES

Technique

INSTRUMENTATION/RECONSTRUCTION

Technique

CLOSURE

Technique

Postoperative Care

35 Intraoperative Urology Consultation

Perioperative Considerations

Delayed Presentation

Safeguards

Ureteral Catheters

Lighted Ureteral Catheters

Intraoperative Cystoscopy

Intraureteral Indocyanine Green

Intraoperative Consultation for Injury

Intraoperative Management of Ureteral Injury

Ureteral Repairs

Endourologic

Technique

Open Options for Repair

Mid-ureteral Injury

Ureteroureterostomy

Distal Ureteral Injury

Boari Flap +/– Psoas hitch (Fig. 35-6)

Bladder Repair

Urethral Repair

Special Considerations

Postoperative Identification of Ureteral Injury

Postoperative Care

PART V Technical Tips for Specific Situations

Chapter 36 Complex Diverticular Disease: Colovaginal and Colovesicle Fistula Repair

Perioperative Considerations

Laparoscopic Approach

Sterile Surgical Equipment

Technique

Port Placement

Procedure Details

Hand Assist

Open

Specific Considerations

Postoperative Care

37 Large Bowel Obstruction

Perioperative Considerations

Positioning

LAPAROSCOPIC DIVERTING LOOP ILEOSTOMY

Perioperative Considerations

Indications

Specific Equipment

Technique

LAPAROSCOPIC DIVERTING LOOP COLOSTOMY

Technique

Indications

Specific Equipment

Procedure

LAPAROTOMY WITH SIGMOID RESECTION ON-TABLE COLONIC LAVAGE, COLORECTAL ANASTOMOSIS, AND DIVERTING LOOP ILEOSTOMY

Technique

Indications

Patient Positioning

Specific Equipment

Procedure

ENDOSCOPIC DECOMPRESSION OF SIGMOID VOLVULUS AND DRAIN PLACEMENT

Technique

Indications

Equipment Needed

Procedure

ENDOSCOPIC PLACEMENT OF SELF-EXPANDING METAL STENT FOR PALLIATION

Technique

Indications

Equipment Needed

Procedure

Postoperative Care

38 Endometriosis

Perioperative Considerations

Symptom Assessment

Clinical Examination

Imaging

Intraoperative Considerations

Technique

CONSERVATIVE, SYMPTOM-GUIDED APPROACH—SHAVING OR PARTIAL-THICKNESS EXCISION

Postoperative Considerations

Outcomes

Surgical Complications

Fertility and Pregnancy

Recurrence

Postoperative Care

39 Trauma of the Colon, Rectum, and Anus

Perioperative Considerations

Diagnosis/Mechanism of Injury

Sterile Instruments/Equipment

Patient Positioning and Preparation

CONDUCT OF TRAUMA LAPAROTOMY

Technique

Injuries of the Colon

Injuries of the Rectum

Damage Control Scenarios

Postoperative Care

40 Ileal Pouch-Anal Anastomosis

Perioperative Considerations

Construction of the J and S Pouch

Sterile Instruments and Equipment

Patient Positioning

Technique

Mucosectomy and Handsewn Anastomosis with a J Pouch

Postoperative Care

41 Crohn Disease: Surgical Management

Perioperative Considerations

Procedures: Laparoscopic Surgery for Inflammatory Bowel Disease

Patient Positioning

Sterile Instruments/Equipment

Traditional Method for Mesentery Ligation and Sutured Anastomosis

Alternative Method

LAPAROSCOPIC TRANSVERSUS ABDOMINIS PREPERITONEAL PLANE BLOCK

Technique

Specific Equipment

Procedure: Laparoscopic Transversus Abdominis Preperitoneal Plane Block

EQUIPMENT LAPAROSCOPIC OR SINGLE-INCISION LAPAROSCOPIC SURGERY DIVERTING LOOP ILEOSTOMY

Technique

Equipment

Traditional Method

Alternative Method

Procedures: Laparoscopic or Single-Incision Laparoscopic Surgery Diverting Loop Ileostomy

MATURING THE STOMA

Technique

Traditional Method

Alternative Method

LAPAROSCOPIC AND OPEN ILEOCOLIC OR SMALL BOWEL RESECTION

Technique

Equipment

Procedure: Laparoscopic and Open Ileocolic or Small Bowel Resection

SURGERY FOR SMALL INTESTINAL STRICTURES—SMALL BOWEL RESECTION AND STRICTUREPLASTY PROCEDURES

Technique

Equipment

Procedure: Surgery for Small Intestinal Strictures—Strictureplasty Procedures

Heineke-Mikulicz Strictureplasty

Finney Strictureplasty

Isoperistaltic Strictureplasty

Special Case: Duodenal Strictures

Postoperative Care

42 Colorectal Cancer: Management of Stage IV Disease

Perioperative Considerations

Surgical Approach to Distant Metastatic Disease

Combined Liver Colon/Colon or Rectum Approach

Surgical Approach to Local Metastatic Disease

Sterile Surgical Equipment

Technique

Positioning and Preoperative Considerations

Abdominal Portion

Pelvic Portion

Perineal Portion

Closure (See Chapter 50)

Palliative Approach to Obstructing Disease

LAPAROSCOPIC SIGMOID COLOSTOMY

Technique

Sterile Surgical Equipment

Surgical Technique

BLOW HOLE/TRAVERSE COLOSTOMY

Technique

Surgical Technique

ENDOSCOPIC STENTING

Technique

Equipment

Postoperative Care

43 Construction of Intestinal Stomas

Perioperative Considerations

Instruments and Equipment

LAPAROSCOPIC

Technique

Ileostomy

Right Transverse Colostomy

Sigmoid Colostomy

OPEN TECHNIQUE

Ileostomy

Colostomy

44 The Difficult Stoma

Risk Factors for the Difficult Stoma

Preoperative Variables

Operative Variables Encountered during Surgery

Ostomy Siting

Perioperative Considerations

Patient Positioning

Equipment and Supplies

Abdominal Wall Defects

Obesity

Tips for Obese Patients

Shortened Mesentery

ILEOSTOMY

Technique

COLOSTOMY

Technique

Postoperative Ostomy Complications and How to Prevent Them

STOMAL COMPLICATIONS

Ischemia

Peristomal Hernia

Technique

Stoma Prolapse

Technique

Parastomal Varices

Stricture

Retraction

45 Complex Abdominal Wall Reconstruction and Parastomal Hernia Repair after Colorectal Surgery

General Perioperative Considerations

Patient Assessment

Operative Approach

Patient Preparation

Mesh Choice

Laparoscopic Parastomal Hernia Repair

Laparoscopic Technique

Positioning

Port Placement

Adhesiolysis

Keyhole Mesh Preparation

Mesh Fixation

Laparoscopic Sugarbaker Technique

Lateralization of the Ostomy

Open Parastomal Hernia Repair

Preoperative Evaluation

Operative Approach

Parastomal Hernia Repair with the Ostomy In Situ

Postoperative Care

Robotic Parastomal Hernia Repair

Summary

46 Kock Pouch (K-pouch)

Perioperative Considerations

Patient Positioning

Approach and Equipment

Technique

Pouch Creation

Valve Creation

Valve Fixation

Closure of the Anterior Wall of the Pouch

Intubation Simulation

Checking for Integrity and Continence

Stoma Creation

Postoperative Care

PART VI Pelvic Floor Disorders

Chapter 47 Rectal Prolapse

Perioperative Considerations

Patient Positioning

Equipment

Anesthesia

DELORME PROCEDURE

Technique

ALTEMEIER PROCEDURE (PERINEAL PROCTOSIGMOIDECTOMY)

Perioperative Considerations

Technique

ABDOMINAL PROCEDURES

Posterior Rectopexy +/– Sigmoid Resection

Postoperative Care

48 Ventral Rectopexy

Perioperative Considerations

An aparitie	2020
Autor	Scott Steele
Dimensiuni	20.96 x 1.91 x 27.31 cm
Editura	LWW
Format	Paperback
ISBN	9781975108250
Limba	Engleza
Nr pag	638