Laparoscopic Liver Pancreas and Biliary Surgery PDF – Textbook and Illustrated Video Atlas
17.23 MB PDF
In the previous century, minimally invasive surgery was introduced to minimize trauma in gastrointestinal operations. After the first laparoscopic cholecystectomy, the indications for a laparoscopic approach increased significantly, particularly in colorectal surgery. Liver and pancreas surgery were initially thought to be unsuitable for laparoscopic techniques, due to the difficulties of safe mobilization and exposure. As a result, a significant number of experts in open hepaticopancreatobiliary surgery were reluctant to incorporate a laparoscopic approach into their practice and/or evaluate it in a randomized controlled trial.
Despite, and because of, significant advances in diagnostic, anesthesiological, and surgical technique that allowed for safer HPB surgery, these advances rarely became the bases for investigating how to make HPB surgery less invasive. This reluctance was rooted in the fear of losing the improvements the open HPB surgery community had achieved. Nevertheless, some expert centers reported on the feasibility and safety of laparoscopic HPB surgery and proved the benefits regarding reduced blood loss and pain, and improved recovery, compared to open liver surgery.
For open surgery, complete knowledge of HPB anatomy is essential. This is even more crucial when considering laparoscopic HPB surgery. For that reason, we have included two chapters on pancreas and liver anatomy by expert surgeons and anatomists from Japan, Drs Sakamoto and Takayama. These chapters will help to elucidate and safely reproduce the laparoscopic surgical techniques shown in the videos.
To date, two consensus conferences have been held on laparoscopic liver resections. One of the conclusions from the first consensus conference, held in 2009, was that laparoscopic resection of segments II and III should be considered the standard of care; the second conference in 2014 indicated that major resections were an innovative procedure, but still in an exploratory phase. An important conclusion by the consensus jury was that a “major focused effort is necessary to determine what laparoscopic skills are required by trainees and HPB surgeons to successfully perform major laparoscopic liver resections.” Claudius Conrad and I hope very much that this textbook and video atlas will help initiate or ease this learning curve.
The development of laparoscopy has also proved to be beneficial in pancreatic surgery, and laparoscopic distal pancreatectomy currently represents the standard of care. Other procedures, such as advanced enucleations, middle pancreatectomy or pancreatoduodenectomy, remain investigational. However, recent series on these advanced pancreatic procedures suggest that laparoscopy offers significant potential in reducing morbidity.
This atlas of minimally invasive HPB surgery has been designed as a high-quality, comprehensive didactic tool. A work of this magnitude could only be achieved by the input of experts from around the world who have extensive experience in treating HPB diseases and are established educators who have successfully mentored many young surgeons. In this atlas, we attempt to elucidate and provide an update on the surgical and perioperative management of HPB disorders from a laparoscopic point of view. Claudius Conrad and I have prepared the didactic videos for both trainees and specialized HPB surgeons in a comprehensive manner with an attempt to present the topics in an easy and understandable format.
What does the future hold for us? A state-of-the-art advancement, stereoscopic vision (3D), is the latest innovation that, in our experience, can significantly reduce both bleeding and operative time. As computer-assisted surgery in the operating room is implemented that includes not only robotics (co-manipulation, so-called cobot) but also cognitics (automated cognition), we can expect to see further improvement and progress in the safety and patient outcomes related to minimally invasive HPB procedures. Already today, patients’ imaging studies are used for virtual 3D modeling and visualization of anatomical or pathological structures. In the future, the synthesis of these advances will allow us to create an augmented reality during surgery. The next step is likely the development of true robotic interfaces to improve safety and reduce operative time and automation of algorithms for a better understanding of operative scenarios and treatments.
The creation of this atlas was undoubtedly dependent on the support and enthusiasm of an expert team. Claudius Conrad and I wish to thank all the authors who agreed to participate in this educational work and share their vast experience. Finally, I would like to thank our editor and Claudius’ editorial team at the University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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