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Single-Port Laparoscopic Surgery in Gynecology
B Ramesh, Madhuri Vidyashankar, Pooja Sharma Dimri
SECTION 1: BASIC PRINCIPLES, INSTRUMENTS AND TECHNIQUES
CHAPTER 1:
Evolution of Laparoendoscopic Single-Site Surgery in Gynecology
EVOLUTION
Hysterectomy, Supracervical Hysterectomy with Adnexectomy
Adnexal Procedures
Other Procedures
NOMENCLATURE
1. LESSCAR Terminology
2. Technical Clinical Issues
3. Skills Training
4. Web-based Secure database Registry
5. Collaboration with other Surgical Societies
EVOLUTION
CONCLUSION
CHAPTER 2:
Indications of Laparoendoscopic Single-Site Surgery
INDICATIONS OF LAPAROENDOSCOPIC SINGLE-SITE SURGERY IN GYNECOLOGY (BOX 1)
CONTRAINDICATIONS OF LAPAROENDOSCOPIC SINGLE-SITE SURGERY IN GYNECOLOGY
CHAPTER 3:
Abdominal Access in LESS
UMBILICUS—THE SITE OF ENTRY
1. Use of operative laparoscope in single-port Laparoscopy [Figs1A, 1B (i & ii)]
2. The single-incision but multi-port Technique (Curcillo and King Technique) [Figs 2 (A-E)] and 2 F(i-viii)
3. Use of a specialized multichannel Access device
OPERATIVE PROCEDURE: ACCESS IN LESS
Entry [Figs 4A to N]
Important Considerations
CLOSURE [Fig 5(A-C)]
CHAPTER 4:
Instruments and Ports
TRIPORT AND QUADPORT ACCESS SYSTEM
Component Parts
Deployment
Advantages1,2
Drawbacks of TriPort and QuadPort devices1
QuadPort
Advantage of QuadPort over TriPort
X-CONE
GELPORT AND GELPOINT SYSTEM
Component Parts
Deployment
SILS PORT
Advantages
Drawbacks
SSL PORT1,3
Advantages
TRANSENTERIX SPIDER
Component Parts
WOUND RETRACTOR AND GLOVE
Deployment
Advantages of Glove and Wound Retractor7,8
Disadvantages1
USE OF VARIOUS INSTRUMENTS IN LESS
1. Standard (Straight) laparoscopic instruments
2. Use of 1.9 mm Needle Instruments
3. Curved Instruments (Figs 11,12,13)
4. Wristed Instruments (Articulated)
Instruments for Hemostasis (Fig. 14)
FUTURE TRENDS—‘SMART INSTRUMENTS’
CHAPTER 5:
Optics for Laparoendoscopic Single-Site Surgery
LAPAROSCOPE
OPTICS OPTIONS FOR LESS
Conventional Laparoscopes
Modified Laparoscopes (Fig. 3)
Endo Eye (Figs 4,5,6,7,8)
Stryker–IDEAL EYES-HD-Articulating Laparoscope
CONCLUSION
CHAPTER 6:
Suturing Techniques in LESS
STEPS OF SUTURING
Intracorporeal Knotting Technique
Extracorporeal Knotting Technique for LESS
Review of Literature
CONTINUOUS SUTURING WITH BARBED SUTURE
ENDOSTITCH DEVICE/SILS STITCH DEVICE17
SILS STITCH ARTICULATING SUTURING DEVICE
CONCLUSION
CHAPTER 7:
Specimen Retrieval
CHAPTER 8:
Benefits of LESS
PAIN
COSMESIS
REDUCTION IN TROCAR SITE COMPLICATIONS—HERNIA, VASCULAR & SOFT TISSUE INJURIES
CHAPTER 9:
Technical Challenges and Limitations of LESS
LOSS OF TRIANGULATION
Solution
INSTRUMENT CROWDING
Solution
REDUCED VISION
Solution
LEARNING CURVE
Solution
PATIENT-RELATED LIMITATIONS
Solution
CONCLUSION
CHAPTER 10:
Skill Training
SIMULATORS IN LAPAROSCOPIC SURGERY
Virtual Reality Simulator Training
The ‘Video’ or ‘Box’ Trainer
Physical Simulation
CONCLUSION
SECTION 2: LESS IN GYNECOLOGY
CHAPTER 11:
LESS in Adnexal Surgery
OOPHORECTOMY/SALPINGO-OOPHORECTOMY
OVARIAN CYSTECTOMY (FIGs 1 TO 7)
REVIEW OF LITERATURE
LESS-Assisted Extracorporeal Cystectomy
Isobaric Extracorporeal Cystectomy without Pneumoperitoneum
extracorporeal cystectomy in pregnancy
Learning Curve for Ovarian Surgery in LESS
CONCLUSION
CHAPTER 12:
Laparoendoscopic Single-Site Surgery for Ectopic Pregnancy
CONCLUSION
CHAPTER 13:
Laparoendoscopic Single-Site Myomectomy
CONCLUSION
CHAPTER 14:
LESS Hysterectomy
INTRODUCTION
PATIENT SELECTION
PATIENT COUNSELING
PRE-OPERATIVE PREPARATION
ACCESS
PORT AND INSTRUMENT SELECTION
Instrument Selection
Laparoscopes
TYPES OF HYSTERECTOMY
LESS LAVH
LESS TLH
Steps of LESS-TLH
The Upper Pedicle (Figs 2A to C, 3A and B, 4 A to C)
Development of Bladder Flap (Figs 5A to E)
The Uterine Pedicles (Figs 6A and B, 7A to C)
Cardinal-Uterosacral Ligament Complex
Opening of the Vault (Figs 8A and B, 9 A to D)
Specimen Retrieval
Vault Closure (Figs 10A to H and Fig. 11)
SPECIAL SITUATIONS
LESS-TLH for Previous LSCS
Bladder Dissection Technique in Cases with Previous LSCS27
LESS TLH for Large Uterus
LESS- SCH (Supracervical Hysterectomy)
COMPARISON WITH 4 PORT CONVENTIONAL TLH/LAVH
COMPLICATIONS
Complications of Laparoscopy
LEARNING CURVE
CONCLUSION
CHAPTER 15:
LESS in Gynecological Oncology
MINIMALLY INVASIVE SURGERY IN GYNECOLOGIC MALIGNANCY
ENDOMETRIAL CANCER
Advantages of Laparoscopy over Laparotomy
OVARIAN CANCER
Concerns about Laparoscopy in Ovarian Cancer30
Advantages of Laparoscopy over Laparotomy
CERVICAL CANCER
Advantages of Laparoscopy Over Laparotomy38
LAPAROENDOSCOPIC SINGLE-SITE SURGERY IN GYNECOLOGIC MALIGNANCY—REVIEW OF LITERATURE
Advantages of LESS in Oncosurgery
Contraindications for LESS in Oncosurgery
Disadvantages of LESS in Oncosurgery
CONCLUSION
CHAPTER 16:
Laparoendoscopic Single-Site Abdominal Sacrocolpopexy for Vaginal Vault Prolapse
COMPLICATIONS
1. Bleeding
2. Injuries to ureter and Bladder
3. Injuries to the Bowel
CONCLUSION
CHAPTER 17:
LESS Concomitant Procedures
CHAPTER 18:
Vaginal Route Single-Site Surgery (Transvaginal NOTES)
CONCLUSION
CHAPTER 19:
Complications of Laparoendoscopic Single-Site Surgery
CLASSIFICATION OF COMPLICATIONS
Complications Specific to the Procedure Performed
Complications Specific to a Laparoscopic Approach
Incidence of Complications
COMPLICATIONS SPECIFIC TO LESS
A. Access-Related Factors
B. Intraoperative Factors
1. Difficulties with viewing
2. Bleeding during single-port laparoscopic surgery
3. Conversion to Standard Laparoscopy or Laparotomy (Fig. 1)
4. Reactive Conversion45,46
5. Pre-emptive or Strategic Conversion45,46
6. Stretching the Port Site for Specimen Retrieval in LESS (Figs 3 & 4)
7. Electrosurgical complications:
C. Postoperative Complications
1. Ecchymosis Around the Access Site and Wound Infection (Figs 5A and B)
2. port site hernia
Operative Factors
Patient Factors
ELECTROSURGICAL COMPLICATIONS IN LESS
RISK FACTORS
MECHANISMS OF ELECTROSURGICAL INJURY (same as in multiport laparoscopy)
1. Direct Coupling (Fig. 9)
2. Capacitative Coupling (Fig. 10)
3. Insulation Failure (Fig. 11)
PREVENTION OF ELECTROSURGICAL INJURY
Steps
Active Electrode Monitoring System (Fig. 12)
CONCLUSION
SECTION 3: RECENT ADVANCES IN LESS
CHAPTER 20:
Robotic-Assisted Laparoendoscopic Single-Site Surgery in Gynecology (R-LESS)
CHAPTER 21:
Newer Trends and Future
LAPAROSCOPIC CAMERA HOLDERS
MAGS-Magnetic Anchoring and Guidance System (Fig. 1)
ACCESS PORT
HYBRID NOTES
ROBOTS IN LAPAROSCOPIC SURGERY
OASIS
COMPUTER-ASSISTED SURGERY
LESS: Our experience—Tips and Tricks for Beginners
ACCESS—THE INCISION IN THE UMBILICUS
Tips & Tricks
ACCESS—INSERTION OF THE ACCESS PORT
Tips & Tricks
CHOICE OF ACCESS PORT
Tips & Tricks
CLOSURE OF THE INCISION
Tips & Tricks
VISION AND OPTICS
Tips & Tricks
INSTRUMENT MANIPULATION & TRIANGULATION
Tips & Tricks
SUTURING
Tips & Tricks
HEMOSTASIS
Tips & Tricks
TISSUE RETRIEVAL
SPECIFIC SITUATIONS
LESS Total Laparoscopic Hysterectomy
LESS Myomectomy
LEARNING CURVE
COMPLICATIONS
CONCLUSION
INDEX
TOC
Index
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