Video 21.1 Kidney Transplantation You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here
Videos 20.1 Intestinal Graft Procurement 20.2 Multivisceral Transplantation Introduction All different types of visceral organ transplants containing small bowel can be categorized into three main prototypes: isolated intestinal, liver-intestinal, and multivisceral transplantations. The proper understanding of vascular anatomy is necessary to procure these different types of visceral allografts in donor surgery. Pancreas and intestinal allografts can be procured by dividing the superior mesenteric artery distal to…
Videos 19.1 Laparoscopic Living Donor Right Hepatectomy 19.2 Open Living Donor Left Hepatectomy Introduction Living donor liver transplant (LDLT) has emerged and is now established as a valuable practice to mitigate the shortage of cadaveric liver grafts. Challenges relate to donor risk and recipient graft function. Preparation for surgery is the most important factor for a successful outcome. The preoperative information about anatomy, volume and function…
Introduction Orthotopic liver transplantation (LTX) has become an accepted means for the treatment of end-stage liver disease. Although the technique of LTX has been refined to a relatively standardized approach, the operation remains a formidable surgical challenge. As such, LTX can have numerous technical complications, which can be influenced by recipient pretransplant condition, donor characteristics, and immunologic factors. These risks can be minimized by appropriate ABO…
Video 17.1 Laparoscopic Splenectomy Introduction The spleen is one of the most commonly injured organs associated with blunt abdominal trauma. Therefore it is not surprising that previously the most common indication for splenectomy was motor vehicle accidents. However, removal of the spleen is not without consequence, as overwhelming post-splenectomy sepsis contributed to increased mortality. Such concerns led to the development of splenic salvage procedures to preserve…
Video 16.1 Laparoscopic Pancreaticoduodenectomy Introduction The first pancreatoduodenectomy was described by Kausch in 1909; however, Allen O. Whipple popularized the procedure for pancreatic head adenocarcinoma in 1935 as a two-stage operation with his report of seven cases. The procedure traditionally involves the en bloc removal of the gastric antrum, duodenum, pancreatic head, gallbladder, and bile duct. The pylorus-preserving technique was introduced by Traverso and Longmire in…
Introduction Distal pancreatectomy refers to resection of a portion of the pancreas extending to the left of the superior mesenteric vein-portal vein (SMV-PV) confluence. First described by Billroth in 1884, distal pancreatectomy is performed for various benign and malignant conditions involving the body and tail of the pancreas, the line of transection depending on the location of the pathology, and goals of the resection. Surgical Anatomy…
Videos 14.1 Laparoscopic Right Hepatectomy 14.2 Laparoscopic Left Hepatectomy 14.3 Robotic Left Hepatectomy Introduction Multiple factors have contributed to a significant increase in the current number of liver surgeries performed annually. Improvements in surgical and anesthetic techniques as well as patient selection have reduced the mortality associated with liver resection to between l% and 5% at experienced centers, with acceptable associated morbidity. The improved surgical outcomes…
Video 13.1 Laparoscopic Transcystic Common Bile Duct Exploration Introduction Approximately 15% of patients with gallbladder stones will also have stones within the common bile duct (CBD). Options for managing CBD stones include endoscopic treatment, including endoscopic retrograde cholangiopancreatography (ERCP) with biliary sphincterotomy, percutaneous interventions, and laparoscopic and open surgical procedures. Individual patient factors, available expertise, and desire for one- versus two-stage treatment will guide management strategy.…
Video 12.1 Laparoscopic Cholecystectomy Introduction Cholecystectomy is one of the most common abdominal surgeries performed. There are many potential complications, and understanding the correct indications is imperative so that the benefits outweigh the risks. Knowing the proper and safe techniques is critical to help minimize those risks, and this begins with an understanding of anatomy and physiology. Anatomy The gallbladder is located between segments IVb and…
Introduction Achalasia is a rare disorder of the esophagus. From the Greek khalasis (to loosen, and Latin a -, without), the disease is characterized by dysphagia and reflux symptoms secondary to inability of the lower esophageal sphincter (LES) to relax, with varying degrees of esophageal dysmotility. Idiopathic achalasia secondary to immune-mediated chronic ganglionitis of the myenteric plexus is the most common variant; rarer causes of achalasia…
Videos 10.1 Linear Stapled Gastric Bypass (Antecolic, Antegastric) 10.2 EEA Stapled Gastrojejunal Anastomosis (Antecolic, Antegastric) 10.3 Sleeve Gastrectomy You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here
Video 9.1 Per-Oral Pyloromyotomy (POP) and Laparoscopic Pyloromyotomy Introduction Gastric emptying procedures may play a role in the management of various disease processes, including benign or malignant gastric outlet obstruction, gastroparesis, and pyloric stenosis. Depending on the diagnosis, treatment options may include medical management, enteral or decompressive access tubes, surgical endoscopy, and surgical resection. A thorough understanding of gastric and duodenal anatomy is important when considering…
Video 8.1 Laparoscopic Total Gastrectomy With D2 Lymphadenectomy Introduction The indications and approaches for gastrectomy have evolved in recent years. Before the introduction of effective diagnostic modalities and medical therapies for peptic ulcer disease (PUD) and Helicobacter pylori infection, most gastric operations were performed for complications of those diseases. Now, malignancy is the most common indication for gastric resection, with more than 26,000 new cases of…
Video 7.1 Laparoscopic Truncal Vagotomy Introduction Gastric acid production contributes to duodenal and gastric ulcer formation. Intraluminal gastric acid is released by parietal cells, which in turn are stimulated via three mechanisms: gastrin, histamine, and acetylcholine. All three mechanisms activate the hydrogen-potassium ATPase-releasing hydrogen ions into the stomach lumen. Specifically, acetylcholine is released in response to parasympathetic stimulation, which travels in the fibers of the vagus…
Video 6.1 Laparoscopic Nissen Fundoplication Introduction Gastroesophageal reflux disease (GERD) remains one of the most common diseases for which patients seek medical treatment. Surgical intervention is offered after failure of maximal medical therapy and/or when an anatomic defect, such as a hiatal hernia, is detected, or if the patient is suffering a complication of reflux such as a stricture. Minimally invasive antireflux surgery serves to reestablish…
Introduction Franz Torek performed the first successful esophagectomy in 1913, after 30 years of dismal results without any survivors. Improvements in technique and patient care have reduced morbidity and mortality; however, esophagectomy remains a high-risk procedure because of the challenging anatomic position of the esophagus, involvement of multiple body cavities in the resection ( Fig. 5.1 ), tenuous blood supply of all reconstruction options, and the…
Introduction The adrenals are paired retroperitoneal glands that lie partially anterior, superior, and medial to the upper pole of the kidneys, bounded by retroperitoneal fat and Gerota’s fascia. The right adrenal gland is posteromedial to the right lobe of the liver and posterior to the inferior vena cava (IVC). The left adrenal gland is lateral to the aorta and posterior to the splenic artery and pancreatic…
Video 3.1 Thyroidectomy and Parathyroidectomy Thyroidectomy Thyroidectomy is the most common endocrine surgical procedure. By definition, a total thyroidectomy requires the resection of both thyroid lobes and isthmus, whereas a thyroid lobectomy requires the resection of one lobe with the isthmus up to the contralateral lobe. Indications for thyroidectomy include benign causes such as mass effect of nodule(s) (on the aerodigestive tract, recurrent laryngeal nerve [RLN],…
Video 2.1 Tracheostomy Introduction Tracheotomy (tracheostomy) is one of the oldest surgical procedures known, with the first reference in 3600 BCE. Chevalier Jackson is credited with standardizing the tracheotomy procedure in 1932, outlining the individual steps for establishing a direct airway through the anterior neck tissues and into the trachea. This technique was subsequently used during the polio epidemic. Throughout the years, this technique has evolved…