Chapter 11. Figure 1.
Figure 1. Right colon and terminal ileum extracted through mini-incision for extracorporeal resection under direct vision.
Figure 1. Right colon and terminal ileum extracted through mini-incision for extracorporeal resection under direct vision.
Figure 10. Proximal and distal transection of sigmoid colon with endoscopic staplers to aid in dissection of sigmoid mass from retroperitoneal structures.
Figure 2. Identification of major regional vessels of the right colon by retraction opposite te mesenteric root.
Figure 3. Dissection in the avascular window on both sides of the ileocolic vessel and ligation with endoscopic clips and endoloops or endoscopic vascular stapler.
Figure 5. Intracorporeal division of inferior mesenteric artery with endoscopic vascular stapler.
Figure 6. Mobilization of rectosigmoid for low anterior resection utilizing endobabcock atraumatic clamps for traction.
Figure 7. Stapling and transection of rectum at the distal line of resection with endoscopic stapler.
Figure 8. Anvil in the proximal colonic segment and circular stapler spike through rectal staple line for colorectal anastomosis.
Figure 9. Proximal and distal mobilization in the presence of a sigmoid mass adherent to the lateral pelvic peritoneum.
Figure 3. Simple interrupted vascular repair. This technique is most useful for small vessel anastomosis.
Figure 1. An incarcerated left indirect hernia before the TAPP dissection is started. The incision (I) in the peritoneum will begin above and lateral to the ring.
Figure 2. A view of the femoral branches of the genitofemoral nerve (N) below the iliopubic tract (I). The cord (C) is being retracted towards the midline.
Figure 3. An internal through a small defect in the peritoneum (PD) below the peritoneal closure (PC). The patient presented with a bowel (B) obstruction 3 days after a TAPP hernia repair.
Figure 4. Trocar hernia with omentum (O) incarcerated in the lateral trocar (LT) site 1 year after a TAPP repair.
Figure 1. Electrosurgical instrument zones.
Zone A- For Action: This is the active part of the electrosurgical instrument. It delivers the energy which will accomplish an expected good effec or an unexpected bad complication. It should be in the field of vision of the surgeon at all time while activated.
Zone B- For Barrier: Indeed, one expects that the insulation of the instrument is perfect and that it provides complete protection, a barrier, aganist electrical energy. But this is not always the case, and microscopic breaks will allow current to pass through and cause unintended burn.
Zone C- Capacitance: It is in this part that stray electricity will discharge from the capacitor if not dispersed. This is usually not directly electrified and is out of site.
Zone D- For Dispersion: The electricity which is induced in the capacitor will be dispersed here through the abdominal wall via a metal conductive sheet.
Zone E- For External: This part is in plain view of the surgeon and staff. The handle of the instrument is insulated for the protection of the surgeon; all the connections are to be seen, checked and coming from an electrosurgical generator which (hopefully) is similiar to the surgeon.
Figure1. Trocar insertion in a patient with bowel adhesions from a previous laparotomy.
Figure 2a. Attachment of the bowel to the anterior abdominal wall. The bowel is attached directly under the umbilicus.
Figure 2. Important landmarks in performance of a laparoscopic presacral neurectomy: view from umbilical laparoscopic sheath.
Figure 2. O-Vicryl suture on a CTB-1 needle is placed around the right uterine artery in preparation for ligation.
Figure 3. A 10 mm tenaculum is inserted into the vaginal delineator, the cervix will be grasped and pulled down into the pelvis in preparation for vaginal morcellation.
Figure 4. Once the uterus is delivered, the vaginal delineator is shown occluding the vaginal cuff, maintaining pneumoperitoneum.
Figure 5. O-Vicryl on a CT-1 needle is used to incorporate the left uterosacral ligament, posterior vaginal wall and right uterosacral ligament for vaginal cuff closure.
Figure 1. Extensive postoperative ecchymosis extending from the suprapubic port site.
Figure 2. Endoscopic clip applied to the lower vena cava following a small venotomy created during a low right para-aortic laparoscopy lymphadenectomy.
Figure 5. Radiograph demonstrating the radiolucent tags of a retained mini-laparotomy pad. These pads were initially placed following a laparoscopic bilateral low para-aortic lymphadenectomy.
Figure 6. Laparoscopic photograph from the umbilical port. The surgeon is placing an imbricating silk suture on the transverse duodenum (t) to imbricate an area which was superficially burned duringa para-aortic lymphadenectomy. TD= Transverse Duodenum; VC= Vena Cava; A= Aorta
Figure 7. Laparoscopic and mini-laparotomy of small bowel herniation complicated by extensive ischemia. Multiple loops of small bowel exteriorized through a mini-laparotomy incision over the herniation site (left lower quadrant port).
Table 2. Complications of Laparoscopic Lymphadenectomy Categorized by Nature and Management.
