Recent Advances in MINIMAL ACCESS SURGERY
Recent Advances in MINIMAL ACCESS SURGERY
Editor-in-Chief
Subhash Khanna MS FICS FIAGES FALS
Head, Department of Minimal Access, Bariatric and GI Surgery Swagat Super Speciality Surgical Institute Dean Swagat Academy of Medical Sciences Guwahati, Assam, India President Indian Association of Gastrointestinal Endo-Surgeons Mumbai, India
Associate Editors
Ramesh Agarwalla
M Kanagavel
Suviraj John
Editorial Board Members
Abhay Dalvi
Ajay Kripalani
Sayandev Dasgupta
Foreword
Daniel B Jones

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Recent Advances in Minimal Access Surgery
First Edition: 2019
9789352709830
Printed at
To my parents for teaching me
the dignity of labor and for blessing me
with their wisdom that shaped my life.
To my wife Dr Swagata for her
unconditional love, understanding and encouragement.
To my children Dr Angshuman, Dr Chaitra and Dr Ayushman
for enriching my life and making it worth living.
I Love You.
- Ahmad Jan FRCS (Eng)
- Senior Fellow in Bariatric Surgery
- Asian Bariatric Hospital
- Ahmedabad, Gujarat, India
- Ahmed Pervez MS (General Surgery)
- Clinical Fellow in Surgical Oncology
- The Christie NHS Foundation Trust
- Manchester, UK
- Amrit Nasta MS DNB (Gen Surg) FMAS (MUHS) FALS (Bariatric)
- Fellowship, Advanced Laparoscopic and Bariatric Surgery, Belgium
- Bariatric and Metabolic Surgery Wockhardt Hospitals
- Mumbai, India
- B Krishna Rau MS FRCS (Eng and Edin) FIAMS FACG FICS FIGSC
- Chairman, 21st Congress of International Society for Laser Surgery and Medicine 2015
- Past President, WFSLMS
- Hon Fellow, American Surgical Association
- Past President, ASI, IAGES, ISLSM, WFLSM
- Chelliah Selvasekar MD FRCS (Ed) MBA
- Consultant Colorectal and Laparoscopic Surgeon
- Department of Surgical Oncology
- The Christie NHS Foundation Trust
- Manchester, UK
- Cuong Duong MBBS PhD FRACS
- Division of Cancer Surgery
- Peter MacCallum Cancer Centre
- Melbourne, Victoria, Australia
- Daniel B Jones MD MS FACS
- Professor of Surgery
- Harvard Medical School
- Vice Chair of Surgery
- Office of Technology and Innovation
- Chief, Minimally Invasive Surgical Services
- Director of the Bariatric Program
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Gómez-Gavara Concepción MD PhD
- HBP and Transplantation Surgery Unit
- Vall d'Hebron University Hospital
- Barcelona, Spain
- Govindara JK
- MBBS MS FIAGES FICS DIP MIS (France) DIP LAP (Germany)
- Chairman
- Dr G Viswanathan Speciality Hospitals
- Dr K Shantha Breast Cancer Foundation
- Tamil Nadu, India
- JC Bose MS MCh Patron
- Dr K Shantha Breast Cancer
- Foundation and Consultant Surgical
- Oncologist
- Dr G Viswanathan Speciality
- Hospitals, Tamil Nadu, India
- Jack Jakimowicz MD PhD
- Medisign, Industrial design department, TU Delft
- Training and Education
- Catharina Hospital
- Eindhoven, Netherlands
- Jaydeep Palep MS FIAGES
- Director and Head
- Department of Bariatric and Minimal
- Access Surgery
- Nanavati Super Specialty Hospital
- Mumbai, Maharashtra, India
- John Spillane FRACS
- Surgeon, Department of General
- Surgery, University of Melbourne
- Melbourne, Australia
- Juneed M Lanker
- MBBS MS (General Surgery) FIAGES FNB (Minimal Access Surgery) FALS
- Senior Fellow Minimal Access Surgery, Apollo Main Hospitals
- Chennai, Tamil Nadu, India
- K Balaji Singh MS FRCS Glas FIAGES FALS Hernia
- Professor and Head
- Department of General Surgery
- Dean, SRIHER
- Chennai, Tamil Nadu, India
- K Lakshmi Kona MS FIAGES FALS
- Senior Consultant MAS and Bariatric Surgery
- Gleneagles Global Hospital
- Hyderabad, Telangana, India
- Karunaharan T MM FIAGES
- Consultant
- Dr G Viswanathan Specialty Hospital
- Tamil Nadu, India
- M Kanagavel
- DNB Surgery MRCS Edin MNAMS FAIS FIAGES FALS Bariatric FALS Hernia EFIAGES FAGIE
- Senior Consultant and PG Faculty
- Department of General
- GI and Minimal Access Surgery
- Research Scholar, SRIHER
- Chennai, Tamil Nadu, India
- Mahendra Narwaria
- MS FICS FIAGES FALS
- Consultant, Bariatric and Robotic Surgeon
- Asian Bariatric Hospital
- Ahmedabad, Gujarat, India
- Mukund Khetan MBBS MS
- Senior Consultant Surgeon
- Institute of Minimal Access, Metabolic and Bariatric Surgery
- Sir Ganga Ram Hospital
- New Delhi, India
- Nadeem Mushtaque Ahmed
- MBBS MS (General Surgery) FIAGES
- FNB Minimal Access Surgery
- Senior Fellow Minimal Access Surgery, Apollo Main Hospitals
- Chennai, Tamil Nadu, India
- Parthasarathy R MS (Gen Surg)
- Consultant Laprascopic Surgeon
- Dr G Viswanathan Speciality
- Hospitals, Tamil Nadu, India
- Parveen Bhatia MS FRCS (Eng) FICS FIAGES (Hon) FMAS FIMSA FAIS FALS (Hon) FCLS
- Founder Chairman and
- Sr Consultant Surgeon
- Institute of Minimal Access, Metabolic and Bariatric surgery
- Sir Ganga Ram Hospital
- New Delhi, India
- Promod Kohli
- MBBS MS MNAMS PhD (Surgery)
- FACS FICS FIAMS FIAGES
- LLB PGD-MLS PGD-HHM
- Medicolegal Consultant and Advisor
- Medical Education, Gurgaon
- Director
- General Surgery and Dean
- Medical Education
- Nayati Medicity, Mathura and Agra,
- Uttar Pradesh, India
- Pradeep Chowbey MS MNAMS FRCS (London)
- Chairman
- Max Institute of Minimal Access,
- Metabolic and Bariatric Surgery
- Max Super Speciality Hospital
- New Delhi, India
- Prasanna Kumar Reddy
- MB FRCS (Edin, Eng, Glasg) FACG (USA) DSc (Hon) Diploma in Surgical Laparoscopy (Fr)
- HOD and Senior Consultant
- Department of Surgical Gastroenterology and
- Minimal Access Surgery
- Apollo Main Hospitals
- Chennai, Tamil Nadu, India
- Rahul Gupta MBBS MS DNB FACS
- Division of Minimally Invasive Surgery and Bariatrics
- Beth Israel Deaconess Hospital
- Beth Israel Deaconess Medical Center
- Instructor in Surgery
- Harvard Medical School
- Clinical Assistant
- Professor of Surgery
- University of Vermont, USA
- Ramen Goel MS FICS
- Director
- Bariatric and Metabolic Surgery
- Wockhardt Group of Hospitals
- Mumbai, Maharashtra, India
- Ravi Teja Pasam MBBS MPH
- Consultant
- Department of Medicine
- Nagarjuna Hospital
- Andhra Pradesh, India
- S Easwaramoorthy
- MS FRCS (Edinburgh) FRCS (Glasgow) FRCS (England) CCST (UK) FAES FIAGES FALS EFIAGES
- Consultant Surgeon
- Dept of Minimal Access Surgery
- Lotus Hospital, Tamil Nadu, India
- SM Chandramohan
- MS MCh SGE FRCS Glas FACS FAIS FIMSA FIAGES
- Head of Department of GI Surgery
- St Isabel's Hospital
- Founder Director, Institute of Surgical Gastroenterology
- Center for Excellence in Upper GI Surgery, Madras Medical College
- Chennai, Tamil Nadu, India
- Sandeep Ganni MBBS MBA
- Clinical Simulation Lab, GSL Medical College, Medisign, Industrial design department, TU Delft
- Training and Education, Catharina Hospital
- Eindhoven, Netherlands
- Sanoop Koshy Zachariah MS FRCS
- Professor and Senior Consultant Surgeon, Head of Unit, Department of General, Gastrointestinal and Laparoscopic Surgery
- MOSC Medical College
- Kochi, Kerala, India
- Srinivasan KN MBBS DMRT DRM
- Secretary, Dr K Shantha Breast Cancer Foundation
- Consultant, Nuclear Medicine Physician and Radiation Oncologist
- Tamil Nadu, India
- Subhash Khanna
- MS FICS FIAGES FALS
- Head, Department of Minimal Access, Bariatric and GI surgery Swagat Super Speciality Surgical Institute
- Dean, Swagat Academy of Medical Sciences
- Guwahati, Assam, India
- President
- Indian Association of Gastrointestinal Endo-Surgeons
- New Delhi, India
- Sudhir Kalhan MBBS MS
- Chairman and
- Sr Consultant Surgeon
- Institute of Minimal Access, Metabolic and Bariatric Surgery
- Sir Ganga Ram Hospital
- New Delhi, India
- Suviraj John
- MBBS MRCSEd MS (Gen Surg)
- DNB (Gen Surg) FNB (MAS) FIAGES FALS (Color-Rectal Surgery) FALS (HPB Surgery) PGD&HM PGQM&AHO
- Sr Consultant Surgeon
- Institute of Minimal Access, Metabolic and Bariatric Surgery
- Sir Ganga Ram Hospital
- New Delhi, India
- TV Aditya Chowdary MS MCh
- Consultant Surgical Gastroenterologist
- Gleneagles Global Hospital Hyderabad, Telangana, India
- V Venkatesh MS FIAGES FALS
- Director
- VG Speciality Hospital
- Tamil Nadu, India
- Vandana Soni MS FIAGES FALS
- Director
- Max Institute of Minimal Access,
- Metabolic and Bariatric Surgery
- Max Super Speciality Hospital
- New Delhi, India
- Vasanth Stalin MD FACS FASMBS2
- Director of Bariatric Surgery
- St Mary's of Michigan
- Department of Surgery
- Genesys Regional Medical Center
- Grand Blanc, Michigan, USA
- Vivek Bindal MS MRCS (Glasgow) DNB FNB (MAS) MNAMS FIUSSTF FACS (USA)
- Vice-Chairman and
- Consultant Surgeon
- Institute of Minimal Access, Metabolic and Bariatric Surgery
- Sir Ganga Ram Hospital
- New Delhi, India
- Also we want to thank the following co-authors for their significant contribution towards preparing the manuscript:
- Arthi Vaishnavi B
- Prasanna Kumar S
- Ramachandrarao P
- Ramya Jayaram
- V Nandini
- Visakan M
The Minimal Invasive Surgery (MIS) revolution began with the laparoscopic cholecystectomy three decades ago. More and more complex operations are being performed with fewer and smaller incisions. Patients benefit with less pain and shorter hospital stays. Enhanced recovery protocols further recuperation. With the introduction of new technologies, come the challenges for training. Robotic surgery shortens the learning curve for minimal access surgery for many surgeons.
Dr Subhash Khanna, President of Indian Association of Gastrointestinal Endo-Surgeons (IAGES), highlights advances in MIS in Recent Advances in Minimal Access Surgery. Topic range from training to the emergence of new techniques and description on novel technologies. This international compilation from experts in the field is a terrific read. Surgery continues to evolve and “Recent Advances in MAS” is a great read for both novice and master surgeons alike.
Daniel B Jones MD MS FACS
Professor
Department of Surgery
Harvard Medical School
Boston, Massachusetts, USA
Preface
Over the past two decades the field of “Minimal Access Surgery” has made continual progress across the globe in an ever increasing fashion, both in the appearance of newer approaches to well established surgical techniques and the emergence of new technologies to further reduce injury to human physiology and anatomy during an endosurgical procedure. The practical amalgamation of the above is an arduous and if not impossible task for the practicing surgeon who must critically appraise the flood of a seemingly endless deluse of published scientific evidence while carrying on his/her busy clinical routine. Yet, the clear imperative is for active clinicians to be able to access the latest emerging clinical evidence in a meaningful manner. With many thousands of surgeons currently actively performing minimal access surgery in extremely different settings, the need for updated clinical information that is relevant and responsible could not be greater.
Recognizing this, the Swagat Academy of Medical Sciences in association with Indian Association of Gastrointestinal Endo-Surgeons (IAGES) has taken up the initiative of providing a rapidly updated clinical resource—The Recent Advances in Minimal Access Surgery.
The first edition aims to provide a topical and practical surgical manual on various emerging and new clinical scenarios and arenas. This being the first edition, emphasis is also laid on new approach to basic sciences. Although in the first article I have given an overview of the progress in the field of endoscopic bariatric surgery, the articles by Rahul Gupta, Daniel Jones and by Jack Jakimowicz covers all the important aspects of the current and future emerging trends in training surgeons. Whereas Sanoop Koshy Zachariah and Venkatesh articles revisit the basics and throw light on current perspective of endoscopic vision and safe access, the other authors cover the most recent trends in colorectal, bariatric and solid organ surgery. Finally the book concludes with a very thought provoking and a must read article by Promod Kohli on medicolegal issues related to these emerging techniques.
I hope the readers will find this book a very valuable resource material for their clinical practice.
Subhash Khanna
ACKNOWLEDGMENTs
The fact of my becoming the President of Indian Association of Gastrointestinal Endo-Surgeons in the year 2018 has been the most significant and memorable event of my life.
As a teacher in Gauhati Medical College, Guwahati, India, I had already dreamt of adding value to the precious life that God Almighty has given me and this was one such occasion not only to fulfill my long cherished dream of writing a medical book but it became an obligation too for me to pay back my association in my best of ability and capacity of what I could do. I took help of my trust, the “Swagat Health and Educational Trust” to fund the book and conceptualized this book, the first edition of a series of books that are going to come forth for the benefit of MAS surgeons and students of surgery.
I thank my wife Professor Swagata for her constant support and encouragement and also my children for bearing with me and tolerating me working at odd hours all throughout.
I must offer my sincere thanks from the core of my heart to all the authors who had been very supportive and I acknowledge the fact that it is because of their efforts that I could come up with this edition as per the target date planned by me.
I would like to place on record my gratitude and indebtedness to the associate editors Ramesh Agarwalla, M Kanagavel and Suviraj John for being on their toes for helping me complete this work on time.
Apart from my team members Dhiman, Nessa and Jadav, I want to offer special thanks to Mr Sabyasachhi Hazra and Ms Nikita Chauhan of Jaypee Brothers Medical Publishers, New Delhi, for constantly guiding, supporting and following up promptly, so that this dream of mine could see the light of the day.
I assure all the readers that it would be an enriching experience for all of you going through the contents on the latest developments in minimal access surgery. I do hope this book will be an asset for all of you in the days to come.