Robotic Surgery for Abdominal Wall Hernia Repair : A Manual of Best Practices

This book is a surgical manual, intended to present and discuss the use of robotic surgery for abdominal wall hernia repair. It comprises the most important surgical approaches in the field, presenting step by step procedures in a clear and didactic way. Abdominal wall hernias are very common conditions, easily identifiable in clinical practice and that usually require a surgical intervention as treatment. However, the choice for the right surgical procedure to treat those conditions may vary, provided the diversity on possible techniques, clinical presentations and complexity. Robotic surgery has emerged in recent years as an important tool to increase the number of surgical approaches for the surgeon who faces abdominal wall hernias. Video-assisted and robotic surgery may represent a consistent improvement in options available for the surgeon involved in wall hernia repair. Current robotic surgical techniques present several of the benefits of common laparoscopic surgery features (such as low invasiveness and fast recovery), and adds some other specific benefits, such as more dynamic and precise movements and a much better view of the operatory field. **__Robotic Surgery for Abdominal Wall Hernia Repair__** is intended to help surgeons to manage this disease from another point of view and to choose the best procedures in each case, pushing medical practice to another level of decisions, investigation and follow up, considering the use of new technologies in robotic surgery. It intends to be a reference manual to medical practitioners who has surgical skills in their backgrounds, but that are not familiar with the use of minimally invasive procedures for abdominal wall complex defects. Foreword 5 Preface 6 Acknowledgments 8 Contents 9 Contributors 11 Biography 13 Preparing a Robotic Program and Surgeon Training Regimen for Hernia and Abdominal Wall 14 Robotic Program and Surgeon Training 14 Surgical Staff 17 Theory Preparation 18 Laboratory 19 Procedure 19 Result 19 Concluding Remarks 20 References 20 Robotic Setup 22 Introduction 22 Operating Room (OR) Setup 23 Patient’s Preparation and Positioning 26 Robotic Docking 28 Getting Started 30 Summary 30 Concluding Remarks 30 Glossary [15] 31 References 31 Robotic Repair of Upper Abdominal Hernias 33 Introduction 33 Anatomy 34 Background 35 Robotic Repair of Upper Abdominal Hernias 36 Single-Dock Retromuscular Repair 36 Double-Dock Retromuscular Repair 39 Preperitoneal Repair 42 Intraperitoneal Repair 44 Summary 44 Concluding Remarks 45 Glossary 45 References 45 Robotic Repair of Lower Abdomen Defects 47 Introduction 48 Techniques 49 Intraperitoneal Onlay Mesh After Primary Closure of the Defect 49 Patient Positioning, Trocar Placement, and Docking 49 Instrumentation 50 Essential Steps 51 Adhesiolysis 51 Primary Closure of the Defect 51 Mesh Placement and Fixation 51 Robotic TAPP Ventral Hernia Repair 52 Essential Steps 52 Developing a Preperitoneal Plane 52 Primary Closure of the Defect 52 Mesh Placement, Fixation, and Reperitonealization 53 Suprapubic Hernias 54 Patient Positioning, Trocar Placement, and Docking 55 Essential Steps 55 Summary 58 Concluding Remarks 58 References 59 Robotic Ventral Hernia Repair from a Lateral Approach 60 Introduction 60 Robotic Transabdominal Preperitoneal (rTAPP) Hernia Repair 61 Surgical Anatomy 61 Preoperative Considerations 62 Patient Prep and Positioning 62 Port Positioning, Docking, and Instrumentation 63 Adhesiolysis and Developing a Preperitoneal Plane 65 Primary Closure of Defect 66 Mesh Placement, Fixation, and Reperitonealization 66 Robotic Transversus Abdominis Release (ROBOTAR) 70 Preoperative Considerations 70 Patient Positioning, Trocar Placement, and Docking 71 Posterior Sheath Mobilization 71 Transversus Abdominis Release 73 Initial Deployment and Fixation of Mesh, Placement of Trocars on the Contralateral Abdomen, and Redocking 73 Contralateral Dissection 73 Closure of the Posterior Sheath, Final Deployment of Mesh, and Restoration of the Linea Alba 76 Concluding Remarks 76 Glossary 82 References 82 Parastomal and Lateral Defects 83 Introduction 83 Problem Evaluation 84 Material and Methods 84 Operative Room and Team Setup 84 Operative Technique 85 Parastomal 85 Adhesiolysis 86 Mesh Repair 87 Lateral Defects 88 Adhesiolysis 88 Mesh Repair 89 Summary 89 Concluding Remarks 91 References 91 Pelvic Defects 94 Introduction 94 Preoperative Workup 95 Patient Preparation and Positioning 96 Getting Started 97 Docking 98 Surgical Technique 98 Dissection/Adhesiolysis 100 Closure of the Defect 100 Mesh Placement and Fixation 101 Complications 102 Results and Perspectives 102 Summary 104 Concluding Remarks 104 Glossary 105 References 105 Postoperative Pain 106 Introduction 107 Postoperative Pain 107 Pneumoperitoneum 107 Deep Neuromuscular Block 108 Chronic Pain 109 Postoperative Management in Robotic Surgery 109 Treatment 109 Multimodal Analgesia 109 Regional Anesthesia 110 TAP Block 111 Approach Considerations 112 Requirements for Performing the Ultrasound-Guided Block 113 Quadratus Lumborum Block 113 Requirements for Performing the Ultrasound-Guided QL Block 114 Dose and Volume of Local Anesthetic 115 Concluding Remarks 115 Glossary 116 References 116 Quality of Life 118 Introduction 118 Definition of Health-Related Quality of Life 119 Applications of Health-Related Quality of Life Measures 120 Selecting and Developing a Health-Related Quality of Life Questionnaire 121 Robotic Surgery for Abdominal Wall Hernia Repair: Immediate Results on Quality of Life 125 Conclusions 130 Concluding Remarks 131 References 131 Anatomical Dissection for Adhesions 136 Introduction 136 Surgical Technique 137 Summary 139 Concluding Remarks 142 References 143 Miscellaneous: Meshes and Sutures 144 Meshes 144 Laparoscopic and Robotic Suture Materials 149 Absorbable Versus Nonabsorbable 150 Tensile Strength 150 Plasticity and Elasticity 150 Ease of Handling and Knot Security 150 Multifilament Versus Monofilament 151 Tissue Reactivity 151 Concluding Remarks 151 Glossary 152 References 152 Molecular Biology 154 Introduction 154 Pros and Cons 155 Mesh: The Necessary Evil 156 A New Look at the Abdominal Wall 157 Restoring or Rehabilitating 157 From Laparoscopic Platform to Robotic Jump 158 Concluding Remarks 160 References 160 Anesthesia for Robotic Surgery 161 Introduction 161 Respiratory Changes 162 Renal Changes 162 Cardiovascular Changes 162 Splanchnic Changes 163 Positioning 163 Trendelenburg Position (Head Down) 163 Reverse Trendelenburg Position (Head up) 164 Arms and Legs Positioning 165 Specific Aspects for Different Procedures 165 Prostatectomy 165 Intra-Abdominal Procedures 166 Thoracic Surgery 166 Transoral Surgery 167 Complications 167 Concluding Remarks 168 References 168 Index 171 Annotation This book is a surgical manual, intended to present and discuss the use of robotic surgery for abdominal wall hernia repair. It comprises the most important surgical approaches in the field, presenting step by step procedures in a clear and didactic way. Abdominal wall hernias are very common conditions, easily identifiable in clinical practice and that usually require a surgical intervention as treatment. However, the choice for the right surgical procedure to treat those conditions may vary, provided the diversity on possible techniques, clinical presentations and complexity. Robotic surgery has emerged in recent years as an important tool to increase the number of surgical approaches for the surgeon who faces abdominal wall hernias. Video-assisted and robotic surgery may represent a consistent improvement in options available for the surgeon involved in wall hernia repair. Current robotic surgical techniques present several of the benefits of common laparoscopic surgery features (such as low invasiveness and fast recovery), and adds some other specific benefits, such as more dynamic and precise movements and a much better view of the operatory field. Robotic Surgery for Abdominal Wall Hernia Repairis intended to help surgeons to manage this disease from another point of view and to choose the best procedures in each case, pushing medical practice to another level of decisions, investigation and follow up, considering the use of new technologies in robotic surgery. It intends to be a reference manual to medical practitioners who has surgical skills in their backgrounds, but that are not familiar with the use of minimally invasive procedures for abdominal wall complex defects Front Matter ....Pages i-xv Preparing a Robotic Program and Surgeon Training Regimen for Hernia and Abdominal Wall (Ivan Cecconello, Evelise Pelegrinelli Zaidan)....Pages 1-8 Robotic Setup (Thiago Nogueira Costa)....Pages 9-19 Robotic Repair of Upper Abdominal Hernias (Jeremy A. Warren, Alfredo M. Carbonell)....Pages 21-34 Robotic Repair of Lower Abdomen Defects (Eduardo ParraDavila, Flavio Malcher, Carlos Hartmann)....Pages 35-47 Robotic Ventral Hernia Repair from a Lateral Approach (Conrad Ballecer, Daniela Cocco, Brian Prebil)....Pages 49-71 Parastomal and Lateral Defects (Ricardo Z. Abdalla, Thiago Nogueira Costa, Cassio Eduardo Silva Gontijo)....Pages 73-83 Pelvic Defects (Thiago Nogueira Costa, Ricardo Z. Abdalla)....Pages 85-96 Postoperative Pain (Pedro Paulo Kimachi, Elaine Gomes Martins)....Pages 97-108 Quality of Life (Ulysses Ribeiro Jr., Silvia Takanohashi Kobayashi, Alessandro Gonçalves Campolina)....Pages 109-126 Anatomical Dissection for Adhesions (Ricardo Z. Abdalla, Danniel Frade Said)....Pages 127-134 Miscellaneous: Meshes and Sutures (Marcelo Furtado)....Pages 135-144 Molecular Biology (Renato Miranda de Melo)....Pages 145-151 Anesthesia for Robotic Surgery (Claudia Marquez Simões)....Pages 153-162 Back Matter ....Pages 163-166