TABLE OF CONTENTS

SECTION 1: ESSENTIALS OF LAPAROSCOPY
1. Chronological Advances in Minimal Access Surgery ......................................................................................... 3
2. Laparoscopic Imaging Systems ............................................................................................................................ 9
• Laparoscopic Trolley 9
• Imaging Systems 9
• Light Source 10
• Light Cable 14
• Telescope 18
• Laparoscopic Camera 20
• Laparoscopic Video Monitor 22
• Television Systems 23
• Three-dimensional Vision 27
• Invention of Ideal Shadow in Laparoscopic Surgery 29
• Three-dimensional Video Systems 29
3. Laparoscopic Equipment and Instrument .......................................................................................................... 32
• Insufflation System 32
• Suction/irrigation System 32
• Energy Source System 33
• Laparoscopic Working Instrument 34
• Port Access Instrument 35
• Laparoscopic Hand Instruments 36
• Outer Sheath of Hand Instrument 38
• Instruments for Sharp Dissection 39
• Types of Laparoscopic Scissors 40
• Endoknife (Scalpel) 42
• Coagulating and Dissecting Electrodes 42
• Needle Holders 43
• Knot Pusher 44
• Laparoscopic Clip Applicator 44
4. Sterilization of Laparoscopic Instruments ......................................................................................................... 51
• History of Sterilization 51
• Legislation in Sterilization 51
• Ultrasonic Technology for Cleaning 52
5. Anesthesia in Laparoscopic Surgery ................................................................................................................. 57
• Evaluation and Preparation of Patient for Laparoscopic Surgery 57
• Physiological Changes During Laparoscopy 58
• Regional Anesthesia 59
• General Anesthesia 59
• Local Anesthesia 60
• Intraoperative Complications 60
6. Abdominal Access Techniques .......................................................................................................................... 67
• Closed Access 67
• Open Access 67
• Closed Access Technique 68
• Introduction of Veress Needle 73
• Primary Trocar Insertion 77
• Pneumoperitoneum in Special Conditions 84
• Entry in Cases of Morbid Obesity 85
• Port Closure Techniques 88
7. Principle of Laparoscopic Port Position ............................................................................................................ 95
• Primary Port Position 95
• Secondary Port Position 95
• First Decide the Target 95
• Port Position in Various Surgeries 97
• Drawbacks of Incorrect Port Position 97
8. Laparoscopic Dissection Techniques .............................................................................................................. 103
• Types of Laparoscopic Dissection 103
• Blunt Dissection 103
• Sharp Dissection 104
• Scissors Dissection 105
• High Frequency Electrosurgical Dissection 105
• Use of the Diathermy Hook 108
• Ultrasonic Dissection 115
• High Velocity Water Jet Dissection 116
• Laser Dissection 116
• Cryotherapy and Radiofrequency Ablation 117
9. Laparoscopic Tissue Approximation Techniques........................................................................................... 120
• Laparoscopic Suturing and Knotting 120
• Laparoscopic Needle 121
• Roeder's Knot 122
• The Meltzer Slip Knot 126
• The Tayside Knot 126
• Using a Pretied Loop 129
• Extracorporeal Knot for Continuous Structure 130
• Cat Eye Stone 131
• Laparoscopic Internal Suturing 131
• Instrumentation 131
• Continuous Suturing 133
• Applications 133
• Interrupted Sutures 136
• Techniques to Assist in Control of Bleeding 137
10. Hand-assisted Laparoscopic Surgery .............................................................................................................. 140
• Hand Port Devices 142
• Omni Port 143
• Indication of HALS 143
• Advantage of HALS 143
• Limitations of HALS 143
• Lapdisc Hand Access Device 144
• Warnings and Precautions 144
• Future Prospect of HALS 144
11. Tissue Retrieval Technique ............................................................................................................................... 149
• Endobags 149
• Colpotomy 151
• Hand-assisted Laparoscopic Surgery 153
• Morcellator 154
12. Laparoscopic Port Closure Technique ............................................................................................................. 158
• Withdrawal of Instrument and Ports 159
SECTION 2: LAPAROSCOPIC GENERAL SURGICAL PROCEDURES
13. Laparoscopic Cholecystectomy ....................................................................................................................... 165
• Advantage of Laparoscopic Approach 166
• Exposure of Gallbladder and Cystic Pedicle 166
• Adhesiolysis 168
• Dissection of Cystic Pedicle 168
• Intraoperative Ultrasonography 171
• Complications of Laparoscopic Cholecystectomy 177
• Lap Chole and CBD Injury 178
• Type of CBD Injury 180
• How to Avoid Injury 181
14. Laparoscopic CBD Exploration ......................................................................................................................... 184
• Intraoperative Cholangiography (IOC) 184
• Laparoscopic Ultrasonography (LUS) 184
• Laparoscopic Extraction of Common Bile Duct Stones 185
• Procedure 186
15. Laparoscopic Appendicectomy ........................................................................................................................ 195
• Laparoscopic Anatomy 195
• Advantage of Laparoscopic Appendectomy 195
• Alternative Port and Theater Set-up 196
• Risk Factors in Laparoscopic Appendectomy 199
16. Laparoscopic Repair of Inguinal Hernia ........................................................................................................... 205
• Laparoscopic Anatomy 205
• Indications of Laparoscopic Repair of Hernia 207
• Advantages of Laparoscopic Approach 207
• Disadvantages of Open Method 207
• Transabdominal Preperitoneal Repair of Inguinal Hernia 208
• Procedure of TAPP 209
• Totally Extraperitoneal Hernia Repair 213
• Advantage of TEP 213
• Disadvantage of Preperitoneal repair 213
• Laparoscopic Repair of Femoral Hernia 216
• Complications of Laparoscopic Hernia Repair 217
• Intraoperative Complications and Precaution 218
• Postoperative Complications 219
• Postoperative Recovery 221
• Recurrence 221
• Causes of Recurrence in Laparoscopic Inguinal Hernia Repair 221
• Recommendation 222
17. Laparoscopic Repair of Ventral Hernia ............................................................................................................ 225
• Laparoscopic Anatomy 226
• Operative Procedure 226
• Choice of Mesh in Ventral Hernia 230
• Surgisis 231
• Aalloderm 231
• Proceed 231
• The Second Technique 231
• Complications 232
• Discussion 232
• Mesh Placement and Fixation 233
• Bowel Injury 234
• Adhesion 235
• Infection 235
• Seroma 235
• Postoperative Pain 236
• Obesity 236
• Recurrence 236
18. Laparoscopic Repair of Hiatus Hernia ............................................................................................................. 239
• Symptoms of Type II Hiatus Hernia 240
• Operative Procedure of Giant Paraesophageal Hernia 241
• Recommendation to Avoid Complication 241
19. Laparoscopic Repair of Duodenal Perforation ................................................................................................ 245
• Laparoscopic Approach has Advantages 246
• Operative Technique 246
• Discussion 248
20. Laparoscopic Fundoplication ........................................................................................................................... 251
• Pathophysiology 251
• Operative Technique 253
• Procedure 254
21. Sleeve Gastrectomy ........................................................................................................................................... 262
• Weight Loss 270
22. Laparoscopic Splenectomy ............................................................................................................................... 274
• Operating Room Set-up and Patient Position 274
23. Laparoscopic Management of Hepaticopancreatic Diseases ........................................................................ 281
• Technique of Laparoscopic Management of Hydatid Cystic Liver 281
• Laparoscopic Liver Resection 282
• Hepatic Resections 284
• Laparoscopic Pancreatic Surgery 286
• Laparoscopic Pseudocyst Drainage 289
24. Diagnostic Laparoscopy .................................................................................................................................... 292
• Indications 292
• Contraindications 293
• Laparoscopic Anatomy 293
• Role of Laparoscopy in Ascites 295
• Diagnostic Laparoscopy 299
25. Laparoscopic Small Bowel Surgery ................................................................................................................. 304
• Laparoscopic Resection of Small Bowel 304
• Ileocolectomy 305
26. Laparoscopic Colorectal Surgery ..................................................................................................................... 310
• Sigmoidectomy 318
• Low Anterior Resection 330
• Abdominoperineal Resection 334
• Hartmann Reversal 336
• Resection Rectopexy 338
• Wells or Marlex Rectopexy 340
• Tips and Tricks 343
27. Laparoscopic Adhesiolysis ............................................................................................................................... 346
• Contraindications 346
• Laparoscopic Adhesiolysis 347
SECTION 3: LAPAROSCOPIC GYNECOLOGICAL PROCEDURES
28. Laparoscopic Sterilization ................................................................................................................................. 353
• Laparoscopic Anatomy 353
• Contraindications 354
• Bipolar Coagulation 355
• Falope Ring Application 355
29. Laparoscopic Ovarian Surgery ......................................................................................................................... 359
• Laparoscopic Ovarian Anatomy 359
• Laparoscopic Management of Ovarian Cyst 360
• Laparoscopic Oophorectomy 363
• Contraindications 363
30. Laparoscopic Tubal Surgery ............................................................................................................................. 368
• Laparoscopic Tubal Anatomy 368
• Operative Procedure 369
31. Laparoscopic Management of Ectopic Pregnancy.......................................................................................... 376
• Ectopic Pregnancy 376
• Discussion 379
• Laparoscopy vs Laparotomy in Treatment of Ectopic Pregnancies 380
32. Laparoscopic Surgery in Pregnancy: Precautions and Complications ........................................................ 381
• Physiological Changes in Pregnancy 382
• Fetal Consideration 383
• Effects of Pneumoperitoneum in Pregnancy during Laparoscopic Procedure 383
• Criteria for Patient Selection 383
• Advantages of Laparoscopy in Pregnancy 383
• Discussion 384
33. Laparoscopic Management of Endometriosis ................................................................................................. 388
• Peritoneal Implants 389
• Resection of Ovarian Endometriosis 390
• Genitourinary Endometriosis 391
• Gastrointestinal Endometriosis 391
• Diaphragmatic Endometriosis 391
34. Laparoscopic Hysterectomy ............................................................................................................................. 392
• Laparoscopic Anatomy of Uterus 392
• Classification 394
• Discussion 399
35. Laparoscopic Myomectomy .............................................................................................................................. 403
• Procedure 403
• Removal of Myoma 404
36. Laparoscopic Management of Stress Incontinence ........................................................................................ 408
• Pathophysiology 408
37. Minimally Invasive Sling Operation for Stress Incontinence .......................................................................... 413
• Tension-free Vaginal Tape 413
• Contraindications of Tension-free Vaginal Tape and Transobturator Tape 418
• Warnings and Precautions 419
38. Laparoscopic Sacral Colpopexy ....................................................................................................................... 422
• Indications 422
• Operative Procedure 422
• Vesicovaginal Fistula Repair 424
• Technique 424
39. Essentials of Hysteroscopy ............................................................................................................................... 428
• Indications 428
• Contraindications 428
• History 428
• Delivery Devices 428
• Distending Media 428
• Fluid Monitoring 428
• Excessive Fluid Absorption 429
SECTION 4: LAPAROSCOPIC UROLOGY
40. Ureteral Injury and Laparoscopy....................................................................................................................... 443
• Ureteral Injuries 443
• Frequency of Ureteral Injury 443
• Level of Ureteral Injuries 444
• Prevention of Ureteral Injury 444
• Recognition of Ureteral Injury 445
41. Laparoscopic Urological Procedure ................................................................................................................. 457
• Laparoscopic Nephrectomy 457
• Laparoscopic Varicocelectomy 458
• Laparoscopic Retroperitoneal Node Dissection 459
• Laparoscopic Management of Lymphoceles 459
• Laparoscopic Ureterolysis 460
• Laparoscopic Ileal Conduit 460
• Laparoscopic Pelvic Lymphadenectomy 460
SECTION 5: PEDIATRIC LAPAROSCOPY
42. Laparoscopic Pediatric Surgery........................................................................................................................ 465
• Laparoscopy in Infants and Children 465
• Laparoscopic Repair of Pediatric Hernia 468
• Laparoscopic Pediatric Urology 470
• Laparoscopy for the Impalpable Undescended Testicle of Intersex Evaluation 471
• Other Laparoscopic Pediatric Urological Procedures 473
SECTION 6: MISCELLANEOUS
43. Other Minimal Access Surgical Procedures .................................................................................................... 481
• Two Port Cholecystectomy 481
• Two Port Repair of Ventral Hernia 486
• Historical Perspective 492
• Surgical Technique 493
• Minimal Access Neck Surgery 496
• Minimal Access Surgery in Orthopedic Surgery 499
• Arthroscopic Surgery in Sports Related Injuries and other Pathology 500
• Minimal Access Surgery in Orthopedic Trauma 501
• Spine Surgery and Arthroscopy 502
• Bone Endoscopy and Tumors 502
44. Minimal Access Bariatric Surgery..................................................................................................................... 505
• Laparoscopic Treatment for Morbid Obesity 505
• Sleeve Gastrectomy 510
45. Complications of Minimal Access Surgery ...................................................................................................... 513
• Anesthetic and Medical Complications in Laparoscopy 513
• Hemorrhagic Complications 519
• Gastrointestinal Complications 522
• Injury to Bladder 524
• Neurologic Injury 526
• Dissection and Thermal Injury 527
• Incisional Hernia 527
• Infection 528
46. Role of Training in Minimal Access Surgery.................................................................................................... 532
• Training—Objectives, Needs, and Means 534
• Present Training in Laparoscopy 534
• Learning Curve in Laparoscopy 537