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Robotic inguinal hernia repair with mesh

Introduction Inguinal hernia is the most common of all primary abdominal wall hernias. Surgical repair of these constitutes 80% of all hernia operations. Over 800,000 inguinal hernias are repaired annually in the United States. Definitive treatment is surgical and can be performed under a variety of approaches including open, laparoscopic, and robotic. Inguinal hernias are most often indirect and on the right. Men are 10 times…

Perioperative optimization of a hernia patient

Indications The principles of hernia repair management are based on the patient’s symptoms, along with the characteristics of the hernia, including the size and location of the hernia defect(s), and the presence of bowel, infection, among other factors. Patients presenting for evaluation with truly asymptomatic hernias can be safely managed non-operatively and followed up for a period of time. However, asymptomatic patients should be counseled appropriately…

Preoperative imaging in hernia surgery

A comprehensive understanding of abdominal wall anatomy is critical for the successful repair of hernias. Such anatomical understanding is generally considered to be practically applied in the operative theater but is perhaps most appropriately utilized in the preoperative evaluation of hernia patients. Successful preoperative planning requires the surgeon to correctly interpret normal and abnormal anatomy on imaging studies and mentally extrapolate these findings into a proposed…

Clinical anatomy and physiology of the abdominal wall

Introduction Novel surgical techniques and technologies (such as retromuscular repairs and robotic surgery) have allowed surgeons to better understand the different layers that constitute the abdominal wall and how they relate to each other. A comprehensive knowledge of these anatomical principles is paramount for successful hernia repair. Recognition of anatomical landmarks and limits will prevent potential neurovascular or structural injury caused by inappropriate dissection during robotic…

Achieving proficiency: Mastering the learning curve

Introduction The number of robot-assisted cases performed by general surgeons continues to rise annually worldwide. , With the adoption of new technology and techniques comes challenges. Implementation of any new technique or adoption of new technology is associated with a learning curve to ensure both proficient surgical skills and, most importantly, patient safety. Currently, there is no standard curriculum for surgeons seeking training in robot-assisted surgery…

Teaching robotic surgery

Introduction The adoption and implementation of new technologies in surgical practice are growing at an exponential rate. The evolution of techniques, devices, and surgical platforms has revolutionized the training experience. New approaches to surgical disease have resulted in a vastly different clinical and operative experience for the current trainees. The ever-changing surgical training landscape has been further challenged by pressure for faculty surgeons to be clinically…

Laparoscopic Portoenterostomy (Kasai Operation)

Access the accompanying videos for this chapter online. Available on ExpertConsult.com . Despite the first successful surgical treatment for correctable biliary atresia (BA) being reported in 1928, very few patients with correctable BA survived long term. In 1959, Professor Kasai described his hepatic portoenterostomy procedure for the first time and ended a long, hopeless era for patients with BA. Unfortunately, Kasai’s original portoenterostomy (KOPE) technique was…

Overview of existing robotic platforms

Introduction Healthcare technology is advancing rapidly and transforming procedures for surgeons and patients alike. Tremendous progress has been made in minimally invasive surgery over a relatively short period of time, with new devices being developed constantly. Robotic surgical devices represent a leap in surgical innovation, and robotic surgery addresses several limitations of manual laparoscopy. In fact, recent data suggest a trend moving away from open procedures…

Laparoscopic Ovarian Surgery

Access the accompanying videos for this chapter online. Available on ExpertConsult.com . Adnexal structures in females include the ovaries, fallopian tubes, and ligaments that support their association with the uterus. Congenital and acquired conditions including benign and malignant diseases can develop at all points in a female’s lifespan. Laparoscopy remains the ideal choice for operative access to diagnosis and treatment of adnexal diseases and disorders. It…

Laparoscopic Orchiopexy

Access the accompanying videos for this chapter online. Available on ExpertConsult.com . Most undescended testes are palpable at various levels in the inguinal canal. Approximately 10% are not palpable and are located in the abdomen. Surgical management of these nonpalpable testes has evolved toward the laparoscopic route, with either a one-stage or a two-stage approach. The primary advantage of laparoscopy over initial inguinal exploration for a…

Laparoscopic Adrenalectomy

Access the accompanying videos for this chapter online. Available on ExpertConsult.com . The laparoscopic approach is ideal for patients with a well-circumscribed, benign-appearing lesion of the adrenal gland. Although neuroblastoma is the most common etiology for adrenal masses in children, these are usually identified late in the disease process and are seldom suitable for laparoscopic resection. However, a well-circumscribed neuroblastoma in the adrenal gland is certainly…

Laparoscopic Cholecystectomy

Access the accompanying videos for this chapter online. Available on ExpertConsult.com . The characteristics of biliary tract disease have been well documented in adults. However, many pediatric providers do not readily consider the possibility of cholecystitis or cholelithiasis in young patients who present with vague upper abdominal pain. However, gallbladder disease is being identified more frequently in children than in the past. The etiology of this…

Laparoscopic Splenectomy

Access the accompanying videos for this chapter online. Available on ExpertConsult.com . Laparoscopic splenectomy was first reported in the 1990s and quickly became the preferred method for splenectomy as well as for the management of other splenic disorders such as splenic cysts and wandering spleen. Laparoscopic partial splenectomy (LPS) has also been utilized in children with heredity spherocytosis (HS) and sickle cell disease (SCD). The main…

Laparoscopic Assisted Pull-Through for Complex Anorectal Malformations and Cloacal Conditions

Access the accompanying videos for this chapter online. Available on ExpertConsult.com . The basic principles of the posterior sagittal anorectoplasty (PSARP) for the repair of anorectal malformations (ARMs) hold true regardless of the surgical approach. The major advantage of the laparoscopic-assisted anorectoplasty (LAARP) approach is improved visualization of the anatomy, a reduced abdominal and perineal surgical incision length, and avoidance of midline division of the levator…

Laparoscopic Duhamel Procedure

Access the accompanying videos for this chapter online. Available on ExpertConsult.com . Treatment of Hirschsprung disease (HD) consists principally of resection of the aganglionic bowel with preservation of the anal sphincter complex. Several operative techniques have emerged over the past 50 years. The proposed advantage of the Duhamel side-to-side anastomosis is the avoidance of dissection of the anterior and lateral part of the distal rectum, preserving…

Laparoscopy-Assisted Pull-Through for Hirschsprung Disease

Access the accompanying videos for this chapter online. Available on ExpertConsult.com . Operative management for Hirschsprung disease (HD) involves removing the aganglionic bowel segment and reconstructing the intestinal tract by bringing normally innervated bowel down to the anus while preserving the anal sphincter mechanism and sensory innervation of the anal transitional zone to ensure good postoperative bowel function. In 1995, the laparoscopic-assisted transanal pull-through (LTAPT) was…

Laparoscopic Total Colectomy With Pouch Reconstruction

Access the accompanying videos for this chapter online. Available on ExpertConsult.com . Many children with familial polyposis (FAP) and ulcerative colitis (UC) can be medically managed into adulthood. However, some suffer from refractory disease, experience adverse disease sequelae (growth retardation and delayed puberty), or suffer treatment-related complications. For these patients, restorative proctocolectomy with ileal pouch–anal anastomosis provides an effective alternative to continued ineffective medical management. Variations…

Laparoscopic Intestinal Operations in the Neonate

Access the accompanying videos for this chapter online. Available on ExpertConsult.com . There are a number of conditions that require an intestinal resection and anastomosis in the neonate. These include intestinal atresia, intestinal duplication, mesenteric cyst, and intestinal stricture (either congenital or after an episode of necrotizing enterocolitis [NEC]). These operations have been routinely performed through a transverse supraumbilical incision. However, almost all of these procedures…

Laparoscopy in the Management of Fecal Incontinence and Constipation

Access the accompanying videos for this chapter online. Available on ExpertConsult.com . Patients who present with the inability to have voluntary bowel movements include those born with anorectal malformations (ARMs), Hirschsprung disease (HD), spinal anomalies, or severe functional constipation. Some of these patients may present with severe constipation, which can cause overflow soiling, while others suffer from true fecal incontinence. Bowel management is a term that…

Laparoscopic Appendectomy

Access the accompanying videos for this chapter online. Available on ExpertConsult.com . Appendicitis is the most common pediatric surgical emergency, with nearly 82,000 appendectomies performed in children each year. There has been widespread adoption of laparoscopy by pediatric surgeons, though there is significant variation in techniques, ranging from a single-incision approach to the traditional three-port technique. Indications for Workup and Operation A child typically presents with…